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Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer
Open accessAbstract
Purpose: To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and Methods: Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Results: Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). Conclusion: These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.
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Cites
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Metadata
- Authors
- Forastiere, A. A., Zhang, Q., Weber, R. S., Maor, M. H., Goepfert, H., Pajak, T. F., Morrison, W., Glisson, B., Trotti, A., Ridge, J. A., Thorstad, W., Wagner, H., Ensley, J. F., & Cooper, J. S.
- Venue
- Journal of Clinical Oncology
- Published
- 2013-03-01
- Volume
- 31
- Issue
- 7
- Pages
- 845-852
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2140753782
- Cited by
- 1,296
- References
- 16
- FWCI
- 61.71
- Type
- journal article
- Language
- en
- Open access
- green
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- Forastiere, A. A., Zhang, Q., Weber, R. S., Maor, M. H., Goepfert, H., Pajak, T. F., Morrison, W., Glisson, B., Trotti, A., Ridge, J. A., Thorstad, W., Wagner, H., Ensley, J. F., & Cooper, J. S. (2013). Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer. Journal of Clinical Oncology. https://doi.org/10.1200/jco.2012.43.6097
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