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European Archives of Oto-Rhino-Laryngology

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01-01-2020 | Cytostatic Therapy | Head and Neck

Single-cycle induction chemotherapy before chemoradiotherapy or surgery in functionally inoperable head and neck squamous cell carcinoma: 10-year results

Authors: Marius Breheret, Dorota Lubgan, Marlen Haderlein, Markus Hecht, Maximilian Traxdorf, Daniela Schmidt, Sarina Müller, Christian Kitzsteiner, Torsten Kuwert, Heinrich Iro, Rainer Fietkau, Sabine Semrau

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2020

Abstract

Introduction

The response to induction chemotherapy (IC) predicts local control after conservative treatment of laryngeal, meso- and hypopharyngeal head and neck squamous cell carcinoma (HNSCC) and can thus help to avoid surgery. Single-cycle induction chemotherapy may help to maintain a low local recurrence rate while keeping the overall toxicity manageable. However, long-term data on single-cycle IC response by tumor location is lacking.

Methods

N = 102 patients with functionally inoperable primary HNSCC of the larynx (n = 43), hypopharynx (n = 42) or mesopharynx/tongue (n = 17) received one cycle of docetaxel (75 mg/m², d1) plus cisplatin (30 mg/m², d1-3) or carboplatin (AUC 1.5, d1-3) and a response evaluation 3 weeks later. Responders (≥ 30% tumor size reduction and ≥ 20% SUVmax decrease in ¹⁸F-FDG PET/CT) were recommended chemoradiotherapy (CRT), and non-responders surgery.

Results

The overall response rate was 72.5%. All 74 responders and 10 non-responders received primary CRT, and 18 patients received primary surgery after single-cycle IC. Overall 10-year local recurrence-free survival (LRFS) was 73.7%. Three-year LRFS was 88.2% (mesopharynx/tongue), 88.2% (larynx), and 73.3% (hypopharynx); p = 0.17. 3-year distant metastasis-free survival (DMFS) was 94.1% (mesopharynx/tongue), 88.0% (larynx) and 76.4% (hypopharynx); p > 0.05. This influenced the 3-year cancer-specific survival (CSS) for larynx (91.2%) vs. hypopharynx tumors (60.8%); p = 0.003, but CSS was not different to tumors in the mesopharynx/tongue (81.4%); p > 0.05.

Conclusions

A single-cycle induction chemotherapy for HNSCC enables surgery plus adjuvant therapy as well as chemoradiotherapy. The long-term local and distant disease control was good but varied between tumors in the larynx and mesopharynx/tongue vs. hypopharynx.

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Title: Single-cycle induction chemotherapy before chemoradiotherapy or surgery in functionally inoperable head and neck squamous cell carcinoma: 10-year results
Authors: Marius Breheret
Dorota Lubgan
Marlen Haderlein
Markus Hecht
Maximilian Traxdorf
Daniela Schmidt
Sarina Müller
Christian Kitzsteiner
Torsten Kuwert
Heinrich Iro
Rainer Fietkau
Sabine Semrau
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keyword: Cytostatic Therapy
Published in: European Archives of Oto-Rhino-Laryngology / Issue 1/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05665-5

At a glance: The STEP trials

Springer Medicine

Single-cycle induction chemotherapy before chemoradiotherapy or surgery in functionally inoperable head and neck squamous cell carcinoma: 10-year results

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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