Comparison of outcome and toxicity of two different regimes of neoadjuvant chemotherapy followed by external beam radiotherapy in stages III and IV larynx and laryngopharyngeal malignancies in years 2013-2014.

INTRODUCTION: Both induction chemotherapy (ICT) followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx/hypopharynx cancer.

MATERIALS AND METHODS: Of the 60 enrolled patients, randomly assigned into two groups (30 in each group) previously untreated patients with stages III to IV larynx/hypopharynx squamous cell carcinoma were assigned to received two cycles of ICT with interval of 3 weeks (a) Group A paclitaxel 175 mg/m 2 on day 1 and carboplatin 450 mg on day 2 (PC), (b) Group B docetaxel and cisplatin 75 mg/m 2 each on day 1 and ifosfamide 2 g/m 2 on day 1-3 along with mesna (docetaxel-ifosfamide-cisplatin). Both groups were followed by conventional radiotherapy (60-70 Gy/5#/week). Primary end point was a response after ICT. Secondary endpoints included acute toxicities and overall response.

RESULTS: Baseline patient and tumor characteristics were well balanced between both groups, the response after ICT seen was 80% in Group A complete response (CR) 36.6% and partial response (PR) 43.3% and in Group B 79% response, CR 33% and PR 46%; whereas toxicities in Group B grade 3/4 neutropenia and grade 2/3 vomiting more severe than Group A. Radiation therapy was well tolerable to both groups with mild side effects.

CONCLUSIONS: Definite role of neoadjuvant chemotherapy in locally advanced larynx/laryngopharyngeal cancer as organ preservation therapy. The efficacy found was quite similar and improved response in both groups except toxicity profile of Group B more severe, requiring the use of colony stimulating factors and supportive care along with.