Chemo-radiation protocol for locally advanced (LA) squamous cell carcinoma (SCC) of the larynx (L) and oropharynx (OP): Organ-preservation and short term mortality

5606 Background: LA SCC of the head and neck compromise 50% of patients(pts) diagnosed at our Institution. Surgical resection is not a curative option in most of the pts. with LA disease. Methods: From Dec 2000 to Nov 2003, 57 pts with L and OP carcinoma were treated with the combination of Cisplatin (C) 100mg/m2 days1,22,43 with standard Radiotherapy (RT), and evaluated for response, toxicity, survival and quality of life in a single institution in Brasil. Results: Median age 55y(25–72), 47 pts with L(82,5%)and 10 pts OP(17,5%), 26 pts were stageIII 45,6%, IVA 42,1% and IVB12,3%, all pts had PS 0–1. 89,4% completed RT with doses 66–70,2Gy (180fr), all pts had at least a 1 week delay after 45Gy; 43 pts received 3 cycles of C(75,4%).Reasons for C interruption: drop in PS 4, nefrotoxicity, ototoxicity, dermatitis, bleeding. Delay of C in 12 pts(21%) and 5pts (8,8%) reduced C dose. GradeIII/IV NCI toxicity include: skin 28%, gastro-intestinal 23%, hematological 5,3%, renal 7%. Median weight loss was 10% of the initial weight, traqueostomy was necessary in 26pts(45,6%) but in 12 pts before and 02 during therapy, 26pts needed enteral feeding(45,6%). Complete response in the primary tumor occurred in 39 pts(68,4%), 02 of this pts had residual lymph nodes, and 16 pts(28,1%) had residual tumor, 2 are not available. Cervical dissection in 4 pts(2 in CR) and salvage laryngectomy in 6pts. 6 pts in CR relapsed, median time to recurrence was 11,2 months(6–19).With a follow-up of 13,7 months(2–35) 17 pts are dead(29,8%) and 35 are alive free of disease(61,4%), 80% of the stage IVB are dead. Median survival for this group is only 6 months (Kaplan-Meier 95% CI 3,4–8,7). There was no statistical survival difference between L and OP pts or N0 and N positive pts p=0,44, 22% and 34% of N0 and N1 patients are dead. In a mutlivariate analysis there was a correlation between age and interruption of RT p=0,004 and of C p=0,04, PS1 pts also had more interruptions of RT then PS0 p=0,0001. Conclusions: Combined therapy with C and RT was feasible and toxicity was similar to previous published series. Although 12% of the pts had previous traqueostomy, 49% of the pts achieved organ preservation and 30% are dead with a short follow-up; stage IVB pts were not good candidates for combine treatment and Rt delays could contribute to short term mortality. No significant financial relationships to disclose.