%0 Journal Article
%T Induction Chemotherapy in Locally Advanced Pharyngolaryngeal Cancers with Stridor: Is It Feasible and Safe?
%A Vijay Maruti Patil
%A Vanita Noronha
%A Amit Joshi
%A Vamshi Muddu
%A Bhavesh Poladia
%A Bharat Chauhan
%A Kumar Prabhash
%A Devendra Arvind Chaukar
%A Pankaj Chatturvedi
%A Gouri Pantvaidya
%A Shashikant Juvekar
%A Anil D'cruz
%J Chemotherapy Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/549170
%X Background. The standard initial management of patients with locally advanced pharyngolaryngeal presenting with stridor is tracheostomy. Tracheostomy has been shown to negatively impact cancer-related outcomes. Methods. Retrospective analysis of prospectively collected data of 9 patients, who underwent induction chemotherapy with the aim of prevention of tracheostomy. Presenting features, time to resolution of stridor, and further management are reported. Results. Eight out of 9 patient received chemotherapy within 12 hours of presentation with stridor. There were 4 patients each with primary hypopharynx and larynx. The stage was IVA in 6 patients and IVB in 2 patients. In all patients receiving immediate chemotherapy, clinical stridor resolved within 48 hours. The radiological response rate was 62.5%. The median reduction in size of tumor was 37%. Conclusion. Immediate neoadjuvant chemotherapy is a feasible and safe option for patients presenting with early stridor and helps in resolution of stridor and avoiding tracheostomy. 1. Introduction Patients with locally advanced pharyngolaryngeal cancer have a poorer prognosis than patients with localised disease at the same site. Around 10% of these patients may present with symptoms and signs of impending airway obstruction in the form of stridor, which should be managed as an oncological emergency [1]. The standard initial management of patients presenting with stridor is endotracheal intubation, tracheostomy, or laser excision for immediate relief of airway obstruction. Among these, tracheostomy and an artificial airway which bypasses the tumour mass are the most commonly utilised method [2]. However, when patients with tracheostomy are subsequently treated with definitive chemoradiation, the response rate, progression-free survival (PFS), and overall survival (OS) have been reported to be significantly lower, compared to those patients with similar stage of disease who did not undergo tracheostomy [3]. The local control rate is poorer even when the patients undergo laryngectomy. Tracheostomy has been associated with inferior duration of OS and increased rate of distant metastasis in some series [4¨C6]. In the last decade there has been a rapid evolution in the use of induction chemotherapy for locally advanced head and neck cancers. The established benefits of induction chemotherapy include a decrease in tumor size and in vivo identification of tumor sensitivity to chemoradiation. Induction chemotherapy regimens containing taxanes and platinum compounds are associated with response rate around 60¨C80% in
%U http://www.hindawi.com/journals/cherp/2012/549170/