Organ-function preservation in advanced oropharynx cancer: Results with induction chemotherapy and radiation Journal Article

Authors: Pfister, D. G.; Harrison, L. B.; Strong, E. W.; Shah, J. P.; Spiro, R. W.; Kraus, D. H.; Armstrong, J. G.; Zelefsky, M. J.; Fass, D. E.; Weiss, M. H.; Wang, R. C.; Schantz, S. P.; Bosl, G. J.
Article Title: Organ-function preservation in advanced oropharynx cancer: Results with induction chemotherapy and radiation
Abstract: Purpose: To evaluate the feasibility and efficacy of a strategy using induction chemotherapy followed by radiation therapy (RT) as a means of organ-function preservation in patients with advanced oropharynx cancer. Patients and Methods: From January 1983 to December 1990, 33 patients with advanced squamous cell oropharynx cancer whose appropriate surgical management would have required a tongue procedure and potential total laryngectomy were treated with one to three cycles of cisplatin (CDDP)-based induction chemotherapy. Patients with a complete response (CR) or partial response (PR) at the primary site then received definitive external-beam RT with or without interstitial implant with or without neck dissection with surgery to the primary tumor site reserved for disease persistence or relapse; patients with less than a PR after chemotherapy had appropriate surgery and postoperative RT recommended. Results: With a median follow-up period of 6.2 years, actuarial overall and failure-free survival rates at 5 years are 41% and 42%, respectively. Chemotherapy toxicity contributed to the death of two patients and was possibly a factor in two others. Local control was achieved in 14 patients (42%) without any surgery to the larynx or tongue. Among 13 patients currently alive, all had a preserved larynx and only one required tongue surgery; 12 of 13 have speech subjectively described as always understandable; and nine of 13 have no significant restrictions in their diet. Conclusion: This treatment program is feasible and effective in patients with advanced oropharynx cancer and produces an excellent functional outcome in most long-term survivors. Modifications to optimize patient selection, minimize toxicity, and improve local control are indicated. The relative toxicity, efficacy, and functional outcome provided by this and other chemotherapy and RT programs versus either standard surgery and/or RT options can only be addressed in a randomized comparison of these therapies.
Keywords: adult; cancer survival; clinical article; controlled study; treatment outcome; aged; laryngectomy; squamous cell carcinoma; cisplatin; fluorouracil; advanced cancer; cancer combination chemotherapy; multimodality cancer therapy; cancer radiotherapy; antineoplastic agent; quality of life; mucosa inflammation; vinblastine; health status; patient compliance; bleomycin; oropharynx cancer; soft tissue tumor; intravenous drug administration; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 13
Issue: 3
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1995-03-01
Start Page: 671
End Page: 680
Language: English
DOI: 10.1200/jco.1995.13.3.671
PUBMED: 7884428
PROVIDER: scopus
Notes: Article -- Export Date: 28 August 2018 -- Source: Scopus
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MSK Authors
  1. Michael J Zelefsky
    615 Zelefsky
  2. Dennis Kraus
    258 Kraus
  3. Stimson P Schantz
    88 Schantz
  4. David G Pfister
    247 Pfister
  5. Jatin P Shah
    538 Shah
  6. George Bosl
    255 Bosl
  7. Elliot W Strong
    36 Strong