Abstract 15: Utility of chemoradioselection for the optimization of treatment intensity in advanced hypopharyngeal and laryngeal carcinoma

• Published in: Clinical cancer research Vol. 23; no. 23_Supplement; p. 15
• Main Authors: Masuda, Muneyuki, Toh, Satoshi, Rikimaru, Hidefumi, Kunitake, Naonobu, Higaki, Yuichiro
• Format: Journal Article
• Language: English
• Published: 01.12.2017
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1557-3265.AACRAHNS17-15

Abstract Background: Definitive concomitant chemoradiotherapy (CRT) with high-dose cis-platinum (CDDP) is a current standard protocol for advanced laryngeal and hypopharyngeal cancer sparing surgery for salvage. However, this modality is associated with limited feasibility and frequent sever toxicities. We have developed a “chemoradioselection” protocol with minimal toxicity using initial response to CRT as a biomarker for patient selection. Materials and Methods: From 2000 to 2012, 123 patients with stage III (44), IV (79) laryngeal (64) and hypopharyngeal carcinoma (59) excluding T4 cases were enrolled to this protocol. Two cycles of split (15 mg/m2 x 5 days, 2000-2008) or bolus (80 mg/m2, 2009-present) CDDP was concurrently administered. Results: Tumor responses were evaluated after 40 Gy of CRT and 64 responders (i.e., chemoradioselected, CRS) received further CRT up to 70 Gy, while radical surgery was recommended for the 59 non-responders (N-CRS), and 34 underwent surgery (N-CRS-ope). The remaining 25 patients who refused surgery (N-CRS-refu) were treated with continuous CRT. The 5-yr overall survival (OS) and disease-specific survival (DSS) were 67% and 77%, respectively. The CRS demonstrated quite favorable 5-yr OS (73%) and 5-yr laryngo-esophageal dysfunction-free survival (LEDFS, 69%). In contrast, the N-CRS-refu showed significantly (P = 0.0193) lower 5-yr OS (47%) than CRS (73%) and N-CRS-ope (70%), and significantly (P < 0.0001) lower 5-yr LEDFS (20%) than the CRS (69%). On multivariate analyses including T, N, primary site, and planned treatment (CRS + N-CRS-ope) or not (N-CRS-refu), unplanned treatment alone showed a significant correlation with poor OS (Hazard ratio [HR]: 2.584, 95% CI: 1.313–4.354, P = 0.007). Conclusions: Chemoradioselection reflects the biological aggressiveness of each tumor, and can segregate patients for functional laryngeal preservation with moderate intensity CRT (150-160 mg/m2 of CDDP) from those who would be better treated with surgery. This strategy may be useful for the optimization of the therapeutic intensity. Citation Format: Muneyuki Masuda, Satoshi Toh, Hidefumi Rikimaru, Naonobu Kunitake, Yuichiro Higaki. Utility of chemoradioselection for the optimization of treatment intensity in advanced hypopharyngeal and laryngeal carcinoma [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 15.