Skip to main content

ORIGINAL RESEARCH article

Front. Oncol.
Sec. Head and Neck Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1394691

Improved survival of locoregional advanced larynx and hypopharynx cancer patients treated according the DeLOS-II protocol

Provisionally accepted
Gunnar Wichmann Gunnar Wichmann *Theresa Wald Theresa Wald *Markus Pirlich Markus Pirlich Matthäus Stöhr Matthäus Stöhr Veit Zebralla Veit Zebralla Thomas Kuhnt Thomas Kuhnt Nils H. Nicolay Nils H. Nicolay Peter Hambsch Peter Hambsch Irene Krücken Irene Krücken Karl T. Hoffmann Karl T. Hoffmann Florian Lordick Florian Lordick Regine Kluge Regine Kluge Susanne Wiegand Susanne Wiegand Andreas Dietz Andreas Dietz
  • University Hospital Leipzig, Leipzig, Lower Saxony, Germany

The final, formatted version of the article will be published soon.

    Introduction Larynx organ preservation (LOP) in locoregional advanced laryngeal and hypopharyngeal squamous cell carcinoma (LA-LHSCC) being only R0-resectable (clear margins > 5 mm) by total laryngectomy (TL) is desirable. Based on tumor-specific (TSS) and overall survival (OS) data from the RTOG 91-11 trial and meta-analyses of randomized clinical trials (RCT), cisplatin-based concurrent radio-chemotherapy (CRT) is discussed being superior to cisplatin-based induction-chemotherapy followed by radiotherapy (IC+RT) and TL followed by postoperative RT (TL+PORT) or radiochemotherapy (TL+PORCT). Outside of RCTs, T4 LHSCC treated with TL+PORCT demonstrated improved OS and TSS compared to CRT alone; comparisons with docetaxel plus cisplatin (TP) -based IC+RT are unpublished. Head-to-head comparisons in RCTs of these 4 alternatives are missing. Material and Methods We utilized monocentric registry data to compare the outcome in the LOP trial DeLOS-II (NCT00508664) and propensity score (PS)-matched LHSCC patients. DeLOS-II utilized endoscopic tumor staging after 1 cycle of TP-based IC for selecting TL+R(C)T for non-responders vs. IC+RT for responders. Main risk factors for survival (localization hypopharynx, T4, N+, tobacco smoking >30 pack years, alcohol consumption >60 g/day, age, sex) were used to calculate the individual PS for each DeLOS-II patient and 330 LHSCC patients suitable for DeLOS-II according to eligibility criteria in Leipzig by CRT (78), TL+PORT (148) and TL+PORCT (104). We performed PSmatching with caliper width 0.2. Results The 52 DeLOS-II patients (whole intent-to-treat cohort) and 3 PS-matched cohorts (52 LHSCC patients each) had equal distribution regarding risk factors including Charlson comorbidity score (CS; all p>0.05) but differed in outcome. During 12,498.6 months of follow-up, 162 deaths (36/41/43/42 in DeLOS-II/ TL+PORCT/ TL+PORT/CRT, p=0.356) occurred; DeLOS-II patients had superior OS and TSS. Compared to DeLOS-II, the HR (95%-CI) observed in TL+PORCT, TL+PORT and CRT for OS and TSS were

    Keywords: head neck squamous cell carcinoma (HNSCC), Larynx cancer, Hypopharynx cancer, treatment outcome, Adjuvant chemotherapy, radiation therapy, radiochemotherapy, larynx organ preservation

    Received: 01 Mar 2024; Accepted: 16 May 2024.

    Copyright: © 2024 Wichmann, Wald, Pirlich, Stöhr, Zebralla, Kuhnt, Nicolay, Hambsch, Krücken, Hoffmann, Lordick, Kluge, Wiegand and Dietz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Gunnar Wichmann, University Hospital Leipzig, Leipzig, 04103, Lower Saxony, Germany
    Theresa Wald, University Hospital Leipzig, Leipzig, 04103, Lower Saxony, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.