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Sequential and alternating chemoradiotherapy comparable for laryngeal cancer

Reuters Health and The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – The results of a randomized trial indicate that sequential and alternating chemotherapy with radiotherapy provide similar survival and larynx preservation in patients with advanced squamous cell cancer of the larynx.

The EORTC trial 24954, reported in the Journal of the National Cancer Institute for February 4, included 450 patients with resectable cancer of the larynx or hypopharynx. In the sequential arm, patients received four cycles of cisplatin and 5-fluorouracil followed by radiotherapy. In the alternating arm, the four chemo cycles were interspersed with radiation therapy.

The former regimen involved 70 Gy of radiation, while the later involved a total of 60 Gy.

During a median follow-up period of 6.5 years, no significant difference in survival rates with a functional larynx was noted between the study groups, lead author Dr. Jean L. Lefebvre, from Centre Oscar Lambret, Lille, France, and colleagues report. Likewise, median overall survival in the sequential and alternating chemotherapy groups was comparable (4.4 vs. 5.1 years) as was the progression-free interval (3.0 vs. 3.1 years).

The rates of grade 3 or 4 mucositis in the sequential and alternating chemotherapy groups were 32% and 21%, respectively. The corresponding rates of later severe edema, fibrosis, or both were 16% and 11%.

“We can conclude that findings from the EORTC trial 24954 are similar to those reported in 1996 that support induction therapy with cisplatin plus 5-fluorouracil as an alternative to laryngopharyngectomy for stage T2-T4, N0-N2 cancers arising in the hypopharynx,” Dr. Arlene A. Forastiere and Dr. Andy M. Trotti, from Johns Hopkins University School of Medicine, Baltimore, write in a related editorial.

Still, the chemoradiotherapy regimens studied are far from perfect, the authors note, adding that “more effective and less toxic approaches are needed.”

J Natl Cancer Inst 2009;101:129-131,142-152.