Bioselection of personalized treatment strategies for advanced laryngeal cancer based on tumor response following a single cycle of neoadjuvant chemotherapy appears to improve long-term disease-specific and overall survival rates, according to authors of an unselected, nonrandomized retrospective cohort study of 247 patients. The study was published in JAMA Otolaryngology-Head & Neck Surgery.
“Very high survival rates were achieved in patients who participated in a bioselective treatment approach using a single cycle of neoadjuvant chemotherapy,” reported Gregory T. Wolf, MD, of the University of Michigan Health System in Ann Arbor, MI, and coauthors. “Excellent survival rates were also achieved in patients selected for concurrent chemoradiotherapy suggesting that the overall optimal treatment approach for patients with advanced laryngeal cancer has not yet been identified.”
Patients with advanced (stage III or IV) laryngeal cancer received neoadjuvant chemotherapy, concurrent chemoradiotherapy, or primary surgery, whereas patients with stage I or II tumors were treated with endoscopic resection, radiotherapy, or chemoradiotherapy.
Multivariate analysis controlling for prognostic factors showed that disease-specific survival was “significantly improved” among patients receiving neoadjuvant therapy compared to those who underwent concurrent chemoradiotherapy (hazard ratio [HR] 0.48; 95% CI, 0.29-0.80).
Among the 153 patients with advanced disease, superior 5-year overall and disease-specific survival was seen among patients with primary surgery and neoadjuvant bioselective therapy compared to chemoradiotherapy—but chemoradiotherapy was associated with higher rates of laryngeal preservation.
1. Wolf GT, Bellile E, Eisbruch A, et al. Survival rates using individualized bioselection treatment methods in patients with advanced laryngeal cancer. JAMA Otolaryngol Head Neck Surg. 2017 Feb 2. doi: 10.1001/jamaoto.2016.3669. [Epub ahead of print]