Laryngeal Preservation in Pyriform Sinus Carcinoma
Condition: Squamous Cell Carcinoma
MeSH terms: Carcinoma; Carcinoma, Squamous Cell
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      Patients were eligible if they had biopsy proven, previously untreated T3 with fixed cord
      involvement squamous cell carcinoma of the pyriform sinus.

      The study compare conventional radiotherapy with concurrent cisplatin to induction
      chemotherapy with cisplatin fluorouracil followed by conventional radiotherapy. The primary
      end point was the preservation of the larynx. The secondary end points included toxicity,
      causes of death and survival rates.
    

Detailed description: 
      Objectives: To compare conventional radiotherapy with concurrent cisplatin to induction
      chemotherapy with cisplatin fluorouracil followed by conventional radiotherapy. The primary
      end point was the preservation of the larynx. The secondary end points included toxicity,
      causes of death and survival rates.

      Design: Multicenter prospective randomized phase III trial. Setting: Academic tertiary care
      center. Patients: Seventy one adult patients with biopsy-proven previously untreated
      resectable T3 with fixed cord involvement squamous cell carcinoma of the pyriform sinus.

      Main Outcomes Measures: Patients were evaluated for toxic reactions, and organ preservation
      and survival rates. Statistical analysis of overall survival and event free survival was
      performed using the Kaplan Meier method.
    

Intervention name(s): induction chemotherapy; Conventionnal chemotherapy
Intervention type(s): Procedure; Procedure
Intervention description(s): Cisplatin was administered intravenously at a dose of 100 mg/m2 on day 1 and fluorouracil was administered at a dose of 1 000 mg/m2/day by continuous intravenous infusion on day 1 to 5 for 2 courses after 3 weeks. After induction chemotherapy patients underwent ears, nose and throat examination and computed tomography imaging. If a complete response (CR) or partial response (PR) of more than 80% is identified in the primary tumor, the patient was offered conventional radiotherapy as part of the protocol treatment. Radiotherapy was administered in 35 fractions of 2 Gy each over a 7 weeks period to the primary tumor (50 Gy) and the neck lymph nodes. The dose to the pathologically positive nodes was supplemented (20 Gy) at a total dose of 70 Gy. Doses and schedules of radiotherapy were identical in both treatment arms of the study.; Intravenous cisplatin at dose of 100 mg/m2 on days 1, 22 and 43 was administered concomitantly with conventional radiotherapy to the primary tumor and to the neck lymph nodes according to the pathological findings of the pre-treatment neck dissection at a total dose of 70 Gy.
- Surgery was recommended to all patients who had a response less than 80%, stable disease or progressive disease in the primary tumor. If surgery was not feasible, the treatment choice was left up to the investigator's discretion.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: squamous cell carcinoma of the pyriform sinus; laryngeal preservation; patients with biopsy-proven previously untreated resectable T3 with fixed cord involvement squamous cell carcinoma of the pyriform sinus