887P - Treatment of elderly patients with locally advanced laryngeal carcinoma with dose-intense chemotherapy followed by radio-chemotherapy: Evading surgical intervention

Background

Locally advanced laryngeal carcinoma is treated by concomitant chemotherapy and radiotherapy then surgery whenever possible. Most patients between 60-70 years refuse surgery, therefore, we designed a treatment in order to postpone or evade the surgical option in elderly patients with T3 and T4 disease.

Methods

In this prospective phase II trial, we included 120 patients diagnosed with locally advanced laryngeal carcinoma (84 patients with T3 disease versus 36 patients with T4 disease) aged between (60-74 years) 67 years in median. Study was started by weekly paclitaxel at a fixed dose of 150mg and carboplatin AUC4 taken on days 1,8 and 15 of a 21-day schedule, cycles were repeated for 6 times. Then patients were evaluated by CT scan and laryngoscopy. Complete responders, partial and non-responders are referred to concomitant radiotherapy (60 Gy) with weekly cisplatin at 50mg for 6 weeks. Patients were followed up for a median of 42 months (38-57 months). Study end point was objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) for 3 years. Secondary end point was toxicity profile.

Results

ORR was observed in 116 patients (96.6%) evaluated by clinical exam, CT scan and laryngoscopy. Complete clinical response was documented in 87 patients after completion of chemotherapy 72.5% (95% CI: 66.2-79.1) and 27.5% partial responders (95% CI: 23.4-31.7). At 3 years of follow-up, PFS was 95% (95% CI: 92.7-98.8) (p value 0.001) while the OS at 3 years was 95%. We have lost 4 patients who died after hospitalization for severe neutropenia and renal failure. Surgery was deleted as an option in this category of patients. The toxicity profile was composed of different grades of neutropenia/thrombocytopenia and anemia. Reversable acute renal failure was seen in 5 patients as well as alopecia. Peripheral neuropathy with different grades was documented in 92 patients.

Conclusions

Neoadjuvant chemotherapy followed by concomitant chemo-radiotherapy in the light of feasibility and acceptable toxicity profile can be a substitution for surgery in elderly patients with locally advanced laryngeal carcinoma taking into consideration the good tolerance and the modest toxicity profile.

Clinical trial identification

Editorial acknowledgement

Funding

Has not received anyfunding.

Disclosure

The author has declared no conflicts of interest.