Chemoradiotherapy Allows Organ Preservation in Tongue Cancer

NEW YORK JAN 21, 2005 (Reuters Health) - Chemotherapy combined with chemoradiotherapy allows organ preservation in patients with advanced resectable cancer of the tongue or hypopharynx, according to a report in the January 1st issue of the Journal of Clinical Oncology.

The base of the tongue and hypopharynx are good candidates for organ preservation because of the potential compromise of speech and swallowing resulting from surgery, the authors explain.

Dr. Susan G. Urba from University of Michigan Medical Center, Ann Arbor, and colleagues investigated the benefits of two cycles of induction chemotherapy followed by chemoradiotherapy for responders in a phase II trial of 59 patients with advanced resectable cancer of the tongue base (n=37) or hypopharynx (n=22).  Fifty-eight percent had stage IV and 42% had stage III disease.

Seventy-eight percent of the patients had a 50% or greater response to induction chemotherapy at their primary tumor site, the authors report.

Of the 43 patients that went on to receive concurrent chemoradiotherapy, 32 (54%) achieved a documented histologic complete response, the results indicate, and 9 additional patients achieved a complete clinical response, but did not undergo the recommended biopsies.

Overall, the researchers note, 44 patients (75%) were deemed organ preservation successes; they did not require salvage surgery of the primary tumor immediately following completion of the treatment because of their excellent responses to therapy.

Apart from one death attributed to the induction chemotherapy, the report indicates, the treatment was well tolerated, the researchers report.

The 3-year overall survival estimate is 67% for base of tongue and 58% for hypopharynx, the investigators report, and the 3-year progression-free survival with organ preservation estimate is 52% for all patients (62% for base of tongue and 34% for hypopharynx).

The researchers point out that these rates compare favorably to other reported data for stage III and stage IV patients like those in this trial.

"Our data show that this organ preservation approach is feasible and tolerable for this selected group of stage III and IV patients in a multi-institutional setting," the authors conclude. "The benefit of induction chemotherapy before chemoradiotherapy is not clearly defined, and deserves further testing in a randomized setting compared with chemoradiotherapy alone."

SOURCE:

• Journal of Clinical Oncology 2005;23:88-95.