Organ preservation in T4a laryngeal cancer: is transoral laser microsurgery an option?

The main objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of T4a laryngeal cancer and to report the oncological and functional outcomes. This is a retrospective case-series study, held in a single-institute, academic tertiary referral center. Seventy-nine patients with previously untreated T4a glottic (n = 31, 39 %) or supraglottic laryngeal carcinoma (n = 48, 61 %) were included in this study. Five patients (6 %) were treated exclusively by TLM, 16 (20 %) had TLM and unilateral neck dissection, 27 (35 %) had TLM and bilateral neck dissection. Adjuvant (chemo)radiotherapy was additionally administered in 26 (33 %) cases following TLM and neck dissection, and in 5 (6 %) cases after TLM without neck dissection. The main outcome measures included organ preservation, local control, functional outcome, overall, recurrence-free, and disease-specific survival. The median follow-up period was 49 months, 5 year organ preservation rate and local control rate were 80.0 and 67.2 %, 5 year overall, recurrence-free and disease-specific survival were 55.8, 61.9 and 71.8 %. The 5 year overall survival rates were 62.5 % in pN0 cases and 57.2 % in cases with pN-positive neck disease. With respect to survival, these results are comparable to total laryngectomy, while being superior to primary (chemo)radiotherapy. TLM results in a low morbidity, rapid recovery and good function and can be a valid option for organ preserving surgery of pT4a glottic and supraglottic cancer.

Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients.

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan-Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85% for pT1/pT2, 82% for pT3, and 76% for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92%, for stages III and IVa 59, 65, and 81%, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.

Results of transoral laser microsurgery in 102 patients with squamous cell carcinoma of the tonsil.

The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13% presented with stage I and II (UICC/AJCC 2002) tumors and 87% with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95%) and with (66%) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan-Meier local and loco-regional control was 78% for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan-Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59% for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.

T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM.

Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan-Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.

Dental therapy before and after radiotherapy--an evaluation on patients with head and neck malignancies.

The present investigation evaluates the dental care situation of patients with head and neck cancer before and after radiotherapy. The situations of these patients in 1993 and 2005 were compared to detect similarities, differences and developments. In the years 1993 and 2005, 37 and 36 patients, respectively, with head and neck cancer treated by the local departments of otorhinolaryngology and of radiotherapy were examined consecutively according to their aftercare appointments. Time points of radiotherapy treatment of the patients evaluated in 1993 varied from 1984 to 1993. The patients evaluated in 2005 had received radiotherapy between 1998 and 2005. Therefore the applied radiotherapeutic regimen differed not only between the two groups of patients, but also within each group. The information for these investigations was provided anonymously. It was evaluated with descriptive statistics. The evaluation of the data shows distinct differences with respect to preventive and therapeutic dental care measures. In 2005, 35 out of 36 patients (97.2%) had a dental consultation before radiotherapy (1993, 65%). All 27 dentate patients (100%) obtained a splint for fluoride application (1993, none). 29% fewer edentulous patients were seen than in 1993. The number of teeth destroyed decreased from 19.2% (1993) to 7.8% in 2005. Mycoses due to Candida spp. and chronic failures in wound healing were rare (5.5%). In the course of the 12 years, prophylactic measures, such as the application of splints for fluoride treatment, were intensified. However, concepts for the dental care of patients undergoing radiotherapy, especially following the radiation, should be widened to avoid ruined teeth and long delayed wound healings.

Organ preserving transoral laser microsurgery for cancer of the hypopharynx.

OBJECTIVE: To assess the feasibility of transoral laser microsurgery (TLM) in the treatment of hypopharyngeal cancer, with a special focus on piriform sinus carcinomas, and to report the oncologic and functional outcomes. STUDY DESIGN: Prospective case-series study at a single institute, an academic tertiary referral center. METHODS: A total of 172 patients with previously untreated squamous cell carcinoma of the hypopharynx were eligible for this study (1986-2003). The piriform sinus was the most common localization (n = 150). Patients with simultaneous second primaries, distant metastases, or N3 neck disease and cancers of the category pT4b were excluded. Fifteen percent of the patients had stages I and II (according to guidelines from the Union Internationale Contre le Cancer 2002/American Joint Commission on Cancer, 2002), and 85% had stages III and IVa. The median follow-up period was 45 months. All patients (n = 172) were treated by TLM, mainly by selective neck dissection (93%) and/or postoperative radiotherapy (52%). Overall survival, recurrence-free survival, organ preservation, and local control were analyzed as end points. Rate of tracheotomies, postoperative complications, and swallowing function (feeding tube dependency) were also analyzed. RESULTS: : Five-year Kaplan-Meier local control was 84% for pT1; 70% for pT2; 75% for pT3; and 57% for pT4a. Five-year Kaplan-Meier recurrence-free survival was 73% for stages I and II, 59% for stage III, and 47% for stage IVa. The whole group of 172 hypopharyngeal cancer patients was analyzed, with an additional special focus on the homogenous group of piriform sinus carcinomas (n = 150). CONCLUSIONS: Our data support the conclusion that TLM is a valid option to standard radical surgery or standard conservation treatment. Oncologic and functional results compare favorably, while morbidity and complication rates tend to be lower.

Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery.

OBJECTIVES: Positive or uncertain surgical margins left untreated have a distinct prognostic relevance in squamous cell carcinoma of the upper aerodigestive tract. An advantage of transoral laser microsurgery is that it can be easily repeated if inadequate resection margins are found postoperatively. The present study investigates the impact of laser surgical reresection on the outcome of patients. STUDY DESIGN: The authors conducted a retrospective unicenter study. METHODS: A review of 1,467 patients with squamous cell carcinoma of the upper aerodigestive tract who were initially treated by transoral laser microsurgery with curative intent between August 1986 and December 2002 was conducted. Locoregional control as well as TNM adjusted and overall survival were analyzed using the Kaplan-Meier method. RESULTS: Three hundred eighty-six patients have required reresection to obtain clear surgical margins, in 70 of whom residual carcinoma has been detected in revision specimens. Patients without need for revision and those in whom revision specimens were found tumor-free had an almost identical locoregional control (P = .4611). In patients with positive revision specimens, however, locoregional control was significantly worsened (P = .0058). Neither the need for reresection nor the detection of further tumor tissue in revision specimens affected TNM adjusted or overall survival. CONCLUSIONS: Survival of patients was similar whether clear resection margins were reached within the first surgical step or with revision surgery. However, patients in whom reresection specimens contained residual carcinoma had an increased risk of locoregional failure and should undergo a further reresection or at least a very close follow up.

Transoral laser microsurgery for advanced laryngeal cancer.

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.

Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck.

PURPOSE: The aim of this study was to evaluate the efficacy of adjuvant radiotherapy after transoral laser microsurgery for advanced recurrent head-and-neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Between 1988 and 2000, 37 patients with advanced local recurrences (23 local and 14 locoregional recurrences) of HNSCC without distant metastases were treated in curative intent with organ-preserving transoral laser microsurgery and adjuvant radiotherapy (before 1994 split-course radiotherapy with carboplatinum, after 1994 conventional radiotherapy). Initial therapy of the primary (8.1% oral cavity, 35.1% oropharynx, 13.5% hypopharynx, and 43.3% larynx) before relapse was organ-preserving transoral laser microsurgery without any adjuvant therapy. RESULTS: After a median follow-up of 124 months, the 5-year overall survival rate was 21.3%, the loco-regional control rate 48.3%, respectively. In multivariate analysis, stage of original primary tumor (Stage I/II vs. Stage III/IV), and patient age (<58 years vs. >or=58 years) showed statistically significant impact on prognosis. In laryngeal cancer, larynx preservation rate after treatment for recurrent tumor was 50% during follow-up. CONCLUSION: Our data show that organ-preserving transoral laser microsurgery followed by adjuvant radiotherapy is a curative option for patients who have advanced recurrence after transoral laser surgery and is an alternative to radical treatment.

Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck.

PURPOSE: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. PATIENTS AND METHODS: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO2 laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). RESULTS: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). CONCLUSION: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy.

Phase I study of continuous mitomycin-C infusion in concomitant radiochemotherapy of primary inoperable advanced head and neck cancer.

PURPOSE: A phase I trial to evaluate the maximum tolerated dose (MTD) of continuous mitomycin-C infusion in radiochemotherapy of inoperable HNSCC. METHODS: Twenty-one patients were treated with 70 Gy (2 Gy/day) and simultaneous chemotherapy (5-FU 600 mg/m2/day and MMC, both as continuous infusion on days 1-5 and 36-40. The MMC dose was dependent on dose escalation levels I-IV: 2/2.6/3.2/4 mg/m2/day. RESULTS: Dose limiting toxicity (DLT) (grade 3 mucositis and/or dysphagia) occurred at dose level IV (MMC 4 mg/m2/day). Accordingly, dose escalation level III (MMC 3.2 mg/m2/day) was set as the MTD. One and 2-year survival rate: 66.7 and 29.5%, disease free survival: 47.6 and 22.8%, respectively. CONCLUSIONS: Our study demonstrates that continuous infusion of 5-FU/MMC can be safely administered at a MMC dose of 3.21 mg/m2/day on days 1-5 and 36-40 in concomitant radiochemotherapy. A phase II study should be initiated to establish the role of this regimen in the treatment of head and neck cancer.

Transoral laser microsurgery for T1a glottic cancer: review of 404 cases.

BACKGROUND: Various therapeutic options exist for treatment of T1a glottic squamous cell cancer (SCC). Radiotherapy (RT) has been favored over surgical excision. This has been challenged by transoral laser microsurgery (TLM) showing low morbidity and good functional results. METHODS: A retrospective chart review was carried out. Patients with untreated T1a glottic SCC were included in the study. Endpoints were locoregional control, overall survival, disease-specific survival, and absolute rate of larynx preservation. RESULTS: Four hundred four patients were included in this study. Five-year Kaplan-Meier estimates were: local control 86.8%, overall survival 87.8%, disease-specific survival 98.0%, recurrence-free survival 76.1%, and larynx preservation 97.3%. The complication rate was 1%; the majority of patients had either normal or mildly dysphonic voices. CONCLUSION: Low complication rates, excellent functional outcome, and high rates of organ preservation favor TLM. In agreement with the literature, TLM should be the treatment of choice for patients presenting with T1a glottic SCC.

Transoral laser microsurgery in treatment of pT2 and pT3 glottic laryngeal squamous cell carcinoma - results of 391 patients.

BACKGROUND: The purpose of this study was to evaluate oncological and functional results of transoral laser microsurgery (TLM) in patients with T2 and T3 glottic laryngeal squamous cell carcinoma (SCC). METHODS: A retrospective chart analysis was carried out. Cases were classified into categories pT2a, pT2b, and pT3. Treatment was exclusively TLM ± selective neck dissection and adjuvant (chemo)radiotherapy. RESULTS: Three hundred ninety-one patients were treated by TLM; 142 cases were category pT2a, 127 were pT2b, and 122 were pT3. Median follow-up was 71 months. Five-year overall, recurrence-free, and disease specific survival rates were 72.2%, 76.4%, and 93.2% for pT2a tumors, 64.9%, 57.3%, and 83.9% for pT2b tumors, and 58.6%, 57.8%, and 84.1% for pT3 tumors, respectively. Larynx preservation was achieved in 93% (pT2a) and 83% (pT2b and pT3). CONCLUSION: Results are comparable to open partial or total laryngectomy and superior to primary (chemo)radiotherapy. TLM results in a lower morbidity and superior function compared to standard treatment.

Enoral laser microsurgery for squamous cell carcinoma of the oral cavity.

BACKGROUND: The purpose of this study was to investigate oncological and functional results of enoral laser microsurgery in treatment for cancer of the oral cavity. METHODS: A retrospective chart analysis was carried out. Two hundred thirty-two patients with cancer of the oral cavity were treated by enoral laser microsurgery ± selective neck dissection ± postoperative (chemo)radiotherapy. RESULTS: Seventy-three percent of the patients (n = 170) received a unilateral or bilateral selective or modified radical neck dissection, 32% (n = 75) received adjuvant (chemo)radiotherapy. The median follow-up period was 71.89 months. The 5-year overall survival (OS) was 54.6%, recurrence-free survival (RFS) was 60.2%, and disease-specific survival (DSS) was 70.3%. Nasogastric feeding tubes were needed in 96 patients, only 2 patients required a temporary gastrostomy tube. CONCLUSION: Enoral laser microsurgery is an efficient therapeutic option in the treatment of oral cavity cancer. Oncological and functional results are comparable to any other treatment regimen, whereas morbidity and complications tend to be lower.

Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery.

BACKGROUND: The purpose of this study was to assess the feasibility of transoral laser microsurgery (TLM) in treatment of pT3 laryngeal cancer. METHODS: We conducted a retrospective case series study of 226 patients with pT3 glottic (n = 122; 54%) or supraglottic laryngeal carcinoma (n = 104; 46%). All patients were treated by TLM in combination with neck dissection (63%) and with postoperative radiotherapy (18%). Our main outcome measures were local control, organ preservation, functional outcome, overall survival, recurrence-free survival, and disease-specific survival. RESULTS: Median follow-up period was 57.8 months. The 5-year organ-preservation and local control rates for all patients were 87% and 71.4%, respectively. The 5-year overall, recurrence-free, and disease-specific survival were 64.4%, 63.0%, and 83.3%, respectively. CONCLUSION: Results are comparable to partial or total laryngectomy, while being superior to primary chemo(radio)therapy. TLM results in low morbidity, rapid recovery, and good function and can be a valid option for organ-preserving surgery of pT3 glottic and supraglottic cancer.

Value of postoperative radiotherapy in patients with pathologic N1 neck disease.

BACKGROUND: The aim of this study was to assess the efficacy of postoperative radiotherapy for the treatment of patients with pathologic N1 neck disease. METHODS: One hundred eighteen consecutive patients with upper aerodigestive tract cancer who were initially treated with curative surgery between 1986 and 2002 and had pN1 disease without extracapsular spread were reviewed. Postoperative radiotherapy was given to 46 patients. RESULTS: Eight isolated regional recurrences were observed, 3 of which occurred in contralateral undissected necks. Seven of the 72 patients treated with surgery alone and 1 of the 46 who received postoperative radiotherapy were affected. The respective 3-year neck recurrence rates amounted to 11.2% and 2.9% (p = .0921). A survival benefit of irradiated patients could not be established. CONCLUSIONS: The data confirm a trend toward improved regional control of pN1 disease if postoperative radiotherapy is applied. However, as a survival benefit is uncertain, use of radiation treatment cannot be recommended generally, but requires individual decisions.

Twenty-five years experience with laser surgery for head and neck tumors : report of an international symposium, Göttingen, Germany, 2005.

During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Göttingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.

Neck lymph node metastases from an unknown primary tumor retrospective study and review of literature.

BACKGROUND AND PURPOSE: Up to 10% of all neck lymph node metastases present without a known primary site. The optimal treatment strategy for these patients is still undefined. The purpose of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor (CUP). Furthermore, prognostic factors and treatment modalities are discussed. PATIENTS AND METHODS: From 1984 to 2003, 28 patients with squamous cell neck metastases from a CUP were treated at the authors' institution. In 17 patients, neck dissection (twelve radical, five modified radical) was performed. In that case, adjuvant radiotherapy was carried out with a mean of 56.7 Gy. In eleven patients, only biopsies were done. These patients received definitive radiotherapy with a mean of 66.8 Gy. In summary, 25 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites. Additional chemotherapy was administered to five patients. RESULTS: The duration of follow-up was 4.1-189.5 months (median 45.1 months). After this period of time, ten patients (36%) remained alive. 5-year overall survival was 40.1%, neck control rate 72.7%. No subsequent primary could be detected. Extracapsular extension and surgery had significant influence on prognosis. Grade 3 toxicity (mucositis or skin reactions) was seen in three patients; no hematologic toxicity > grade 2 was observed. 19 patients suffered from grade 2 xerostomia. CONCLUSION: With radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials.

Concomitant radiochemotherapy in primary inoperable advanced head and neck cancer with 5-fluorouracil and mitomycin-C.

BACKGROUND: The purpose of this study was to evaluate the efficacy and toxicity of radiotherapy and concomitant 5-fluorouracil (5-FU) and mitomycin-C infusion in inoperable head and neck cancer. METHODS: Seventy-six patients (86% men, 14% women), mean age 57 years, with primary inoperable head and neck cancer were treated with 70 Gy plus simultaneous intravenous chemotherapy with 5-FU (600 mg/m(2)/d, days 1 to 5) and mitomycin-C (10 mg/m(2), day 5 plus 36). RESULTS: After a mean follow-up of 13 months, 31 patients were alive. Complete response (CR) was seen in 63%. The 1- and 2-year overall survival rates were 67.7% and 39.5%, and locoregional control rates were 51.7% and 35.6%. Pretreatment hemoglobin <13.9 g/dL was associated with lower locoregional control rates (p = .03). Therapy was well tolerated (grade 3 mucositis in 21%, grade 4 in 1%, grade 3 leukopenia in 11%). CONCLUSIONS: Our radiochemotherapy regimen offers a curative option for this group of patients with a poor prognosis. Hemoglobin levels before therapy have an influence on prognosis.