Main Session
Sep
29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care
3563 - Induction Systemic Therapy followed by Definitive Chemoradiation for T4 Larynx and Hypopharynx Cancer
Presenter(s)
Nader Mohamed, MD - NYU Langone Health, New York, NY
N. Mohamed1, J. Xiao1, V. Diaz1, A. S. Wanna1, R. White2, Z. Li2, K. Csehak2, M. Rybstein3, A. E. Vaezi4, A. Jacobson5, M. Persky5, L. Moses5, U. Duvvuri5, M. Tam1, K. S. Hu1, and C. Hill1; 1Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, 2Department of Medicine, NYU Grossman School of Medicine, New York, NY, 3Department of Medicine, NYU Grossman Long Island, Mineola, NY, 4Department of Otolaryngology, NYU Grossman Long Island, New York, NY, 5Department of Otolaryngology, NYU Grossman School of Medicine, New York, NY
Purpose/Objective(s):
Patients with clinical T4 laryngeal and hypopharyngeal cancers were underrepresented in seminal organ preservation (OP) trials, and subsequent analyses have raised concerns for decreased overall survival (OS) with non-surgical management. A subset of patients may decline surgical treatment in favor of OP or are medically inoperable. Induction systemic therapy (IST) followed by chemoradiation (CRT) represents a potential alternative treatment strategy, but clinical data to guide treatment decision-making after IST are limited. We hypothesized that responders to IST would have improved outcomes after CRT compared to non-responders.Materials/Methods:
We retrospectively reviewed patients with T4 larynx or hypopharynx cancer treated with IST followed by definitive CRT at a single institution (January 2017–December 2025). Clinical and treatment variables were abstracted from medical records. Survival was estimated using Kaplan–Meier methods. Fisher’s exact test was used to compare categorical variables.Results:
Twenty-one patients were included with a median follow-up of 15.1 months (1.4-123.8). Median age was 62 years (27–78) with 76% being male and 81% were former smokers (median 15 pack years). Laryngeal primaries comprised 57% of the cohort. Twelve patients declined surgery; the rest were not surgical candidates. All received IST (66.7% chemotherapy (C-IST); 33% chemoimmunotherapy (CI-IST)), and the median baseline CPS was 15 in the C-IST group and 5 in the CI-IST group. After IST, all received CRT to 69.96–70 Gy in 33–35 fractions; one patient received definitive quad shot (59.2 Gy/16 fractions). PEG tubes were utilized in 62% of patients during CRT. Median radiographic reduction in maximum dimension post-IST was 48% for C-IST versus 68% for CI-IST. Four deaths occurred, one from disease progression. Median OS was not reached; 1-year OS was 83.1%. One-year local failure (LF) and distant failure (DF) rates were 28.4% and 36.6%, respectively. Seven DFs occurred early (median 4.1 months); six (86%) had received C-IST. Three (43%) were salvaged with local therapy, including SBRT. Five patients developed LF: four received C-IST alone and one was enrolled on a randomized trial (placebo vs CI-IST). Patients with a =50% response to IST had lower LF events, but this was not statistically significant (13% vs 50%, p=0.11). For salvage, one patient underwent total laryngectomy. Of the remaining four, one had prior distant metastasis, one had synchronous distant failure, one declined surgery and chose palliative therapy, and one died before salvage treatment.Conclusion:
Patients demonstrating a biological response to IST potentially have a lower risk of local failure with OP strategies. Adding immunotherapy may induce a deeper response to IST, which may help further mitigate the risk of local and distant failure. These data are hypothesis-generating, and larger prospective trials are needed to evaluate the utility of bioselective responses to IST in clinical decision-making.