RECIST criteria - complete response, partial response, stable disease, progressive disease
Veterans Administration Cooperative Study
randomised 332 patients with Stage III or IV glottic or supraglottic carcinoma to receive laryngectomy and postoperative radiotherapy or 3 cycles of neaodjuvant cisplatin and 5FU chemotherapy followed by definitive radiotherapy in responders. Larynx preservationwas possible in 64% of patients randomized to the neoadjuvant chemotherapy arm without detriment to overall survival.
- 3 arm study comparing neoadjuvant chemotherapy followed by radiotherapy versus concurrent chemoradiotherapy versus radiotherapy alone. There was no difference in the survival rates, but the rates of laryngeal preservation were higher in the groups assigned to either concurrent chemotherapy or neoadjuvant chemotherapy.
Neoadjuvant chemo - cisplatin/5-fu 5–6 days via an intravenous infusion every 3 weeks. Usually 2–6 cycles
EORTC 22931 trial
randomised 334 patients to receive either post-operative concurrent chemoradiotherapy or radiotherapy alone. Concurrent treatment has improved the 3 year disease free survival from 41% to 59% and the 3 year overall survival from 49% to 65%. There is no difference in the rate of metastatic relapses.This benefit is at the cost of increasing acute radiotherapy toxicity (grade 3 and above) from 21% to 41%. Concurrent CRT should be considered for high risk postoperative cases (for instance, those with positive margins or extracapsular extension in nodal disease).