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OBJECTIVE To evaluate the efficacy and toxicity of definitive and postoperative radiotherapy (RT) for laryngeal carcinoma patients aged ≥70 years. METHODS Data of patients between December 2006 and January 2016 were retrospectively analyzed. In total, 66 (4 females and 62 males) patients were evaluated for this analysis. The median age was 74 (range, 70-86 years) years. The total RT dose was 70 Gy and 60-66 Gy for definitive and postoperative settings with 2 Gy per fraction, respectively. RESULTS The median follow-up time was 29.5 (range, 4-126 months) months. Using the tumor, node, metastasis (TNM) classification, tumors were stage IIA (18.2%), stage IIIA (31.8%), stage IIIB (3%), and stage IVA (47%). The purpose of RT was definitive for 33 (50%) patients and postoperative for 33 (50%) patients. Concomitant chemotherapy was used in 21 (31%) patients with 9 (42%) receiving cetuximab and 12 (58%) receiving cisplatin. Cisplatin dose reduction was needed in 20% patients, but cetuximab was used as per a suggested protocol. The 3-year local relapse free (LRF), metastases free (MF), and overall survival rates for all patients were 74%, 84%, and 48%, respectively. Only 26 (40%) patients died due to disease specific problems, and 18 (27%) patients died of unknown causes. In the toxicity evaluation, no grade 3-4 adverse effect was seen. Any type of cytopenia status was reported in 14 (21%) patients, and this rate was statistically higher in concomitant radiochemotherapy group (p=003). CONCLUSION RT seems to be an effective therapy in elderly population either alone or concomitant with chemotherapy in definitive and postoperative settings. In contrast, comorbid diseases should be managed carefully in the treatment and follow-up periods. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of induction chemotherapy (IC) followed by bioradiotherapy (BRT) to achieve functional larynx preservation in the setting of locally advanced head and neck tumors.Methods and Materials: This was a phase 2, open-label, multicenter study of patients with stage III and IVA laryngeal carcinoma who were candidates for total laryngectomy. The primary endpoint was the rate of survival with functional larynx (SFL) at 3 years, with a critical value to consider the study positive of SFL >59%. Patients received 3 cycles of IC with TPF (docetaxel, cisplatin, and 5-fluorouracil), and those who responded received conventional BRT with cetuximab. In patients with residual nodal disease after BRT, neck dissection was planned 2 months after BRT. Patients who did not respond to IC underwent total laryngectomy plus neck dissection and radiation therapy.Results: A total of 93 patients started TPF. Responses to IC on larynx target lesion were as follows: 37 patients (40%) showed a complete response; 38 patients (41%) showed a partial response; 8 patients (9%) showed stabilization; 2 patients (2%) showed progressive disease, and 8 patients (9%) were not evaluated (2 deaths, 5 adverse events, and 1 lost to follow-up). Seventy-three patients (78%) received BRT: 72 as per protocol, but 1 with only stable disease. Median follow-up was 53.7 months. Three-year actuarial rates were as follows: SFL: 70% (95% confidence interval [CI] 60%-79%); laryngectomy-free survival: 72% (95% CI 61%-81%); overall survival: 78% (95% CI: 63%-82%). The acute toxicity observed during both IC and BRT was as expected, with only 1 toxicity-related death (local bleeding) during BRT.Conclusions: According to this protocol, the SFL rate was clearly higher than the critical value, with acceptable levels of toxicity. The use of cetuximab added to radiation therapy in patients with stage III and IVA laryngeal cancer who respond to TPF could improve functional larynx preservation. A phase 3 trial is warranted. [ABSTRACT FROM AUTHOR]

Two patients diagnosed with advanced head and neck cancer were treated with cetuximab 400 mg/m2 intravenously for one loading dose followed by 250 mg/m2 IV on days 1, 8, and 15 along with paclitaxel 80 mg/m2 and cisplatin 30 mg/m2 intravenously on days 1 and 8 repeated every 21 days for three cycles (CPP). Maintenance cetuximab 250 mg/m2 intravenously weekly was continued following the aforementioned regimen for one year or until disease progression. Patient A was diagnosed with squamous cell carcinoma of the parotid gland treated initially with parotidectomy and radiation therapy. After the detection of multiple lung metastases, he received three cycles of CPP and maintained a stable disease after one year. Patient B was diagnosed with metastatic laryngeal cancer and was initially treated with three cycles of docetaxel, cisplatin, and continuous infusion fluorouracil (TPF) followed by chemoradiation with cisplatin. After one year, recurrence was observed, and she was treated with laryngopharyngectomy. After another year, recurrence was observed , and CPP was initiated. Further progression was noted shortly after completion of cycle 3. There are limited data supporting the use of regimens similar to CPP in advanced head and neck cancer. Further study is needed to determine the relative efficacy and safety of CPP compared with other regimens containing monoclonal antibodies targeting the epidermal growth factor receptor, taxanes, platinum agents, and/or fluorouracil. [ABSTRACT FROM AUTHOR]