Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer

Arlene A. Forastiere, Qiang Zhang, Randal S. Weber, Moshe H. Maor, Helmuth Goepfert, Thomas F. Pajak, William Morrison, Bonnie Glisson, Andy Trotti, John A. Ridge, Wade Thorstad, Henry Wagner, John F. Ensley, Jay S. Cooper

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Abstract

Purpose To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and Methods Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Results Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). Conclusion These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.

Original languageEnglish (US)
Pages (from-to)845-852
Number of pages8
JournalJournal of Clinical Oncology
Volume31
Issue number7
DOIs
StatePublished - Mar 1 2013

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Laryngeal Neoplasms
Larynx
Radiotherapy
Therapeutics
Cisplatin
Laryngectomy
Induction Chemotherapy
Drug Therapy
Survival
Organ Preservation
Squamous Cell Neoplasms
Radiation Oncology

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Forastiere, Arlene A. ; Zhang, Qiang ; Weber, Randal S. ; Maor, Moshe H. ; Goepfert, Helmuth ; Pajak, Thomas F. ; Morrison, William ; Glisson, Bonnie ; Trotti, Andy ; Ridge, John A. ; Thorstad, Wade ; Wagner, Henry ; Ensley, John F. ; Cooper, Jay S. / Long-term results of RTOG 91-11 : A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 7. pp. 845-852.
@article{a5eb8de784414884b292532348e8bdfc,
title = "Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer",
abstract = "Purpose To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and Methods Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Results Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95{\%} CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95{\%} CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95{\%} CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95{\%} CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95{\%} CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8{\%} v 20.8{\%} with induction chemotherapy and 16.9{\%} with RT alone). Conclusion These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.",
author = "Forastiere, {Arlene A.} and Qiang Zhang and Weber, {Randal S.} and Maor, {Moshe H.} and Helmuth Goepfert and Pajak, {Thomas F.} and William Morrison and Bonnie Glisson and Andy Trotti and Ridge, {John A.} and Wade Thorstad and Henry Wagner and Ensley, {John F.} and Cooper, {Jay S.}",
year = "2013",
month = "3",
day = "1",
doi = "10.1200/JCO.2012.43.6097",
language = "English (US)",
volume = "31",
pages = "845--852",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "7",

}

Forastiere, AA, Zhang, Q, Weber, RS, Maor, MH, Goepfert, H, Pajak, TF, Morrison, W, Glisson, B, Trotti, A, Ridge, JA, Thorstad, W, Wagner, H, Ensley, JF & Cooper, JS 2013, 'Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer', Journal of Clinical Oncology, vol. 31, no. 7, pp. 845-852. https://doi.org/10.1200/JCO.2012.43.6097

Long-term results of RTOG 91-11 : A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. / Forastiere, Arlene A.; Zhang, Qiang; Weber, Randal S.; Maor, Moshe H.; Goepfert, Helmuth; Pajak, Thomas F.; Morrison, William; Glisson, Bonnie; Trotti, Andy; Ridge, John A.; Thorstad, Wade; Wagner, Henry; Ensley, John F.; Cooper, Jay S.

In: Journal of Clinical Oncology, Vol. 31, No. 7, 01.03.2013, p. 845-852.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term results of RTOG 91-11

T2 - A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer

AU - Forastiere, Arlene A.

AU - Zhang, Qiang

AU - Weber, Randal S.

AU - Maor, Moshe H.

AU - Goepfert, Helmuth

AU - Pajak, Thomas F.

AU - Morrison, William

AU - Glisson, Bonnie

AU - Trotti, Andy

AU - Ridge, John A.

AU - Thorstad, Wade

AU - Wagner, Henry

AU - Ensley, John F.

AU - Cooper, Jay S.

PY - 2013/3/1

Y1 - 2013/3/1

N2 - Purpose To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and Methods Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Results Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). Conclusion These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.

AB - Purpose To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and Methods Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Results Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). Conclusion These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.

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