Concurrent chemotherapy and radiotherapy for organ preservation in advanced XXXX .

@entity1 @entity137 @entity5 @entity900 @entity1487
BACKGROUND: Induction chemotherapy with @entity900 plus @entity1487 followed by radiotherapy is the standard alternative to total laryngectomy for @entity1 with locally advanced @entity5 . The value of adding chemotherapy to radiotherapy and the optimal timing of chemotherapy are unknown. METHODS: We randomly assigned @entity1 with locally advanced @entity5 of the larynx to one of three treatments: induction @entity900 plus @entity1487 followed by radiotherapy, radiotherapy with concurrent administration of @entity900 , or radiotherapy alone. The primary end point was preservation of the larynx. RESULTS: A total of 547 @entity1 were randomly assigned to one of the three study groups. The median follow-up period was 3.8 years. At two years, the proportion of @entity1 who had an intact larynx after radiotherapy with concurrent @entity900 (88 percent) differed significantly from the proportions in the groups given induction chemotherapy followed by radiotherapy (75 percent, P=0.005) or radiotherapy alone (70 percent, P<0.001). The rate of locoregional control was also significantly better with radiotherapy and concurrent @entity900 (78 percent, vs. 61 percent with induction @entity900 plus @entity1487 followed by radiotherapy and 56 percent with radiotherapy alone). Both of the chemotherapy-based regimens suppressed distant metastases and resulted in better disease-free survival than radiotherapy alone. However, overall survival rates were similar in all three groups. The rate of high-grade toxic effects was greater with the chemotherapy-based regimens (81 percent with induction @entity900 plus @entity1487 followed by radiotherapy and 82 percent with radiotherapy with concurrent @entity900 , vs. 61 percent with radiotherapy alone). The @entity137 of concurrent radiotherapy and @entity900 was nearly twice as frequent as the @entity137 of the other two treatments during radiotherapy. CONCLUSIONS: In @entity1 with @entity5 , radiotherapy with concurrent administration of @entity900 is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for laryngeal preservation and locoregional control.
