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Concurrent Radiotherapy and Triweekly Carboplatin for the Definitive Treatment of Locally Advanced Laryngeal Carcinoma

Lu, Sharon, M., MD*; Iganej, Shawn, MD*; Abdalla, Iman, A., MD; Buchschacher, Gary, L., MD

American Journal of Clinical Oncology: June 2018 - Volume 41 - Issue 6 - p 595–600
doi: 10.1097/COC.0000000000000330
Original Articles: Head and Neck

Purpose of the Study: In 2003, our institution adopted triweekly carboplatin (tCb) area under the curve (AUC) 5 as an alternative to high-dose cisplatin (100 mg/m2) for select patients receiving definitive concurrent chemoradiation for locally advanced laryngeal carcinoma (LALC). Here, we present our experience and outcomes with this definitive concurrent chemoradiation regimen.

Methods: From January 2003 through December 2013, 53 patients with stage III (60%) or IVA (40%) LALC were treated with tCb AUC 5 and concurrent radiotherapy to 70 Gy without neoadjuvant chemotherapy. Reasons for using carboplatin instead of cisplatin in these patients were: age 70 and older (21%), poor renal function (6%), presence of 1 or more major comorbid condition(s) (36%), and per discretion of the treating medical oncologist (38%). Primary disease site was glottis in 22 (42%) patients and supraglottis in 31 (58%) patients.

Results: Median follow-up time was 63 months for surviving patients. Out of the 53 patients, 43 (81%) received all 3 cycles of carboplatin and all patients received their intended dose of radiotherapy. Although 17 (32%) patients required a feeding tube during treatment, only 2 (4%) required it long term. There were no acute treatment-related grade 4 or 5 hematologic toxicities. On last follow-up, 14 (26%) patients had died of intercurrent disease. For the subgroup of “RTOG 9111 eligible” patients in our cohort (n=46), 5-year estimates of overall survival, disease-free survival, laryngectomy-free survival, larynx preservation, and locoregional control were: 49%, 42%, 39%, 80%, and 63%, respectively.

Conclusions: In patients with LALC who are suboptimal candidates for high-dose cisplatin, our experience suggests that tCb AUC 5 with concurrent radiotherapy provides acceptable outcomes with tolerable toxicity.

Departments of *Radiation Oncology

Medical Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA

The authors declare no conflicts of interest.

Reprints: Sharon M. Lu, MD, 4950 Sunset Blvd, Los Angeles, CA 90027. E-mail: sharon.m.lu@kp.org.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.