Chemotherapy alone for stage II-IVa laryngeal squamous cell carcinoma: A 20-year follow-up.

Abstract

Current treatment options for nonmetastatic laryngeal squamous cell carcinoma include radiotherapy, chemoradiotherapy, and surgery, which can result in significant morbidity. This study reports the 20-year outcomes of a single-modality chemotherapy as a larynx preservation strategy in patients with stage II-IVa laryngeal squamous cell carcinoma (LSCC). In this single-institution, single-arm, prospective clinical trial, 31 patients with stage II-IVa LSCC received three or four cycles of paclitaxel, ifosfamide, and a platinum agent (TIP). Patients with a pathologic complete response (pCR) by biopsy assessment received three additional cycles without local therapy. Patients with a partial response underwent conservation laryngeal surgery (CLS). The primary end point was 2-year larynx preservation rate (LPR). Secondary end points included recurrence-free survival (RFS), overall survival (OS), and long-term complications. With a median follow-up time of 21 years, 11 patients (35%) achieved a pCR and were managed with chemotherapy alone. None required laryngectomy, and only one experienced recurrence, which was successfully salvaged with radiotherapy. Among 19 patients who underwent CLS or radiotherapy, seven experienced recurrence and six required laryngectomy. The 20-year LPR was 72%; median OS was 13.5 years, and median RFS was 10.3 years. Patients with a pCR had significantly fewer long-term complications, including lower rates of feeding tube and tracheostomy dependence (p < .01). This long-term follow-up reinforces that TIP alone is an effective larynx preservation strategy in patients with LSCC who achieve a pCR. Further investigations of systemic therapy for laryngeal cancer treatment, including less toxic combinations and immunotherapy as well as incorporating tissue- and blood-based biomarkers, are warranted.