Originally published as JCO Early Release 10.1200/JCO.2008.17.6396 on March 16 2009

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Durable Long-Term Remission With Chemotherapy Alone for Stage II to IV Laryngeal Cancer

F. Christopher Holsinger, Merrill S. Kies, Eduardo M. Diaz, Jr, Ann M. Gillenwater, Jan S. Lewin, Lawrence E. Ginsberg, Bonnie S. Glisson, Adam S. Garden, Nebil Ark, Heather Y. Lin, J. Jack Lee, Adel K. El-Naggar, Waun Ki Hong, Dong M. Shin, Fadlo R. Khuri

From the Departments of Head and Neck Surgery, Thoracic/Head and Neck Medical Oncology, Radiology, Radiation Oncology, Biostatistics, and Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Winship Cancer Institute, Emory University, Atlanta, GA.

Corresponding author: Fadlo R. Khuri, MD, Emory Winship Cancer Institute, 1365 Clifton Rd, NE, Ste 3000, Atlanta, GA, 30322; e-mail: fkhuri{at}emory.edu.

Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting.

Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment.

Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy.

Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

Both F.C.H. and M.S.K. contributed equally to this work.

Supported by peer-reviewed funding from Bristol-Myers Squibb Co's Investigator Initiated trials program, The University of Texas M. D. Anderson Cancer Center Support Grant No. CA 16672, discretionary funds obtained from patient donations and departmental funds; The University of Texas Faculty Incentive Award (F.C.H.), The University of Texas M. D. Anderson Recruitment Funds, Specialized Program of Research Excellence in Head and Neck Cancer Grant No. P50 CA97007 from the National Cancer Institute, National Institutes of Health (F.C.H.), and "Clinician Investigator Program in Translational Research" Grant No. K12 CA88084 (F.C.H.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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