Induction Docetaxel/Cisplatin/5-fluorouracil (TPF) as Selector for Chemo Radiation Therapy (RT) Versus Partial Laryngectomy in Advanced Laryngeal Cancer

Inclusion Criteria:

• Patients must have pathologically confirmed previously untreated, resectable, squamous cell carcinoma of the larynx.
• Disease must be Stage III or IV.
• Tumor must be potentially surgically resectable and curable with conventional surgery and radiation therapy.
• Patients must undergo pre-treatment endoscopic tumor staging and CT scanning of chest and neck.(pet scan optional)
• Eastern Cooperative Oncology Group (ECOG) Performance status 0-2.

• Pre-treatment laboratory criteria:

  • WBC > 3500/ul, granulocyte > 1500/ul.
  • Platelet count > 100,000/ul.
  • Calculated or measured creatinine clearance > 60 cc/min.
  • AST and ALT < 2.5 X ULN
• Patients must give documented informed consent to participate in this study.

Exclusion Criteria:

• Prior head and neck malignancy or active non-head and neck malignancy. Except for cured non-melanoma skin cancer,
• Prior head and neck radiation.
• Documented evidence of distant metastases.
• Active infection.
• Pregnancy or lactation. Patients must agree to use adequate contraception (hormonal or barrier method of birth control) prior to study entry, for the duration of study participation and for 3 months after discontinuing therapy.
• Any medical or psychiatric illness which in the opinion of the principal investigator would compromise the patient's ability to tolerate this treatment.
• Age < 18 years.
• Patients with psychiatric/social situations that would limit compliance with study requirements are not eligible.
• Patients with Grade > 2 peripheral neuropathy.
• Any history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80.

Criteria for supracricoid resection for chemo selection non responders

Inclusion Criteria :

• At least one functional arytenoids (physical and radiological examinations)
• Involvement of thyroid cartilage including extrathyroid cartilage extension.

Exclusion criteria:

• Subglottic extension anteriorly.
• Pre epiglottic extension.
• Subglottic extension laterally.
• Interarytenoid involvement.
• Two Arytenoids involved.

Criteria for supracricoid resection for Chemoradiation failure:

Inclusion Criteria:

• At least one functional arytenoid (physical and radiological examinations)
• Involvement of thyroid cartilage (with no radiological evidence for extra thyroid Extension).

Exclusion Criteria:

• Extrathyroid cartilage extension.
• Involvement preepiglottic space.
• Subglottic extension.
• Interarytenoid involvement.