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| Title: | A
Single Institution Experience with Accelerated Fractionated Radiation
by Concomitant Boost (AFX-CB) and Concurrent Chemotherapy for Advanced
Larynx Carcinoma |
| Author(s): | M. Eaton1, K. Hu1, B. Culliney1, S.Schantz2,
D.Frank1,2, S. Malamud1, M. Persky1, R. Sessions1, P. Han1, L.
Harrison1,2 |
| Purpose: | Recent data (RTOG 90-03 and RTOG 99-14) strongly suggest that concomitant boost radiation (AFX-CB) as well as concurrent chemoradiation offer a local control advantage to advanced head and neck cancer patients. Current enrollment in RTOG -0129 has sought to address if AFX-CB with concurrent cisplatin is superior to standard radiation plus cisplatin. Here we report on Beth Israel Medical Center’s experience with AFX-CB plus concurrent chemotherapy in treating advanced larynx cancer. |
| Methods: | From 4/00-11/05, 34 patients with newly diagnosed
stage II-IVb larynx cancer were treated with AFX-CB to 70Gy/6 weeks
(BID RT last 2 weeks) with 2 cycles of concurrent CDDP (100mg/m2)
weeks 1 and 4 or weekly and daily carboplatin (n=9) . The median
age was 59 (range 36 to 76), 26 were male, 25 were treated with
cisplatin with 2 patients switching to weekly carboplatin (AUC 2)
after 1 dose of cisplatin and 2 patients received 3 doses of cisplatin.
Disease characteristics were as follows: 1997 AJCC stage: II-1;
III-16, IVa-16, IVb-1. The distribution of tumor and nodal stages
were as follows: T2-5, T3-27, T4a-2, N0-13, N1-4, N2a-1, N2b-10,
N2c-5, N3-1. The median radiation dose was 70Gy. |
| Results: | At a median follow-up of 17.5 mo. (range 2-71 mo.) and mean follow-up of 34 mo., the crude local control rate (LC) was 76.5%, regional control (RC) was 88.2%, and freedom from distant metastasis (FFDM) was 85.3%, and disease-free survival (DFS) was 73.5%. Of the 9 failures 6 occurred within 7 months of finishing treatment. One patient recurred with a distant failure only. For all patients, the 3 year actuarial LC, RC, LRC, FFDM, and DFS were 72%, 84%, 69%, 80%, and 65% based on Kaplan Meier estimate. The most common acute CTC Grade 3 or greater toxicities were as follows:odynophagia 19 (55%); hoarseness 7 (21%); dermatitis 4 (12%). Mucositis could not be accurately assessed as regular endoscopy was not performed during treatment. Nine patients required hospitalization primarily for intractable nausea/dehydration (n=4) and pneumonia (n=2). There were no treatment related mortalities. Pretreatment PEG placement was done in 29 patients. Median percent weight loss was 10.5% (range 3-24). Median pretreatment hemoglobin was 13.1g/dl and post-treatment 11.8 g/dl. Twenty patients required a treatment break: median treatment break time 3 days (range 1-14 days). Of the 20 pts, 3 patient had treatment break > 5days (7,9 and 14 days). Chronic CTC grade 3 or greater toxicities included: dysphagia 10 (29%); osteoradionecrosis 1 pt (3%); hoarseness 3 pts (9%) as well as Grade 2 xerostomia in 17pts (52%). At last followup (3 to 45 months), 8 patients had their PEG still in place: 3 could not swallow solids or liquids; 3 could swallow both liquids and solids and 1 could swallow only liquids. Three of the 8 patients had local failure while the PEG remained in place. |
| Conclusion: | AFX-CB with concurrent chemotherapy for advanced
larynx carcinoma provides encouraging rates of locoregional control
and organ preservation. Dysphagia is the major acute and chronic
toxicity. A therapeutic gain in terms of locoregional control or
toxicity profile of such a regimen remains to be compared vis-à-vis
the current standard regimen of conventional fractionation with
3 cycles of high dose cisplatin as will be determined in RTOG H-0129. |
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