Combination Chemotherapy Plus Radiation Therapy To Preserve the Larynx in Patients With Cancer of the Hypopharynx or Larynx

DISEASE CHARACTERISTICS:

• Histologically proven squamous cell carcinoma of the head and neck, including:

  • Stage III/IV cancer of the glottic or supraglottic larynx

    • Eligible T4 tumor defined as:

      • Bulging the valleculae
      • Bulging the hyothyroid membrane
      • Minimal thyroid cartilage invasion or suspicion of invasion on imaging

  • Stage II/III/IV cancer of the pyriform sinus or of the hypopharyngeal aspect of the aryepiglottic fold (with or without extension to postcricoid area)

    • No massive destruction of the thyroid cartilage
    • No continuity between primary tumor and a lymph node

• Operable on first attempt (as assessed by head and neck surgeon) by classical total laryngectomy with or without partial pharyngectomy

  • No requirement for extended surgery (circumferential pharyngolaryngectomy)
  • No tumor suitable for partial (functional) surgery or requiring extended surgery that necessitates any kind of flap for closure
  • No N2c tumor unless no requirement for bilateral resection of internal jugular veins

• Measurable or evaluable disease by panendoscopy and CT scan or MRI

  • Esophagoscopy required
  • Bronchofiberscopy recommended
• No requirement for tracheotomy

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• ECOG 0-2 OR
• WHO 0-2

Hematopoietic:

• WBC at least 4,000/mm^3

Hepatic:

• Bilirubin no greater than 2.0 times normal

Renal:

• Creatinine no greater than 1.5 mg/dL OR
• Creatinine clearance at least 60 mL/min

Other:

• No medical, psychological, or geographical condition that precludes study compliance
• No serious nonmalignant systemic disease

• No second malignancy except:

  • Carcinoma in situ of the cervix
  • Adequately treated nonmelanomatous skin cancer
• No poor nutritional status unlikely to be restored to fair status within 3 weeks
• No contraindication to CT scan or general anesthesia

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No prior anticancer biologic therapy

Chemotherapy

• No prior anticancer chemotherapy

Endocrine therapy

• No prior anticancer endocrine therapy

Radiotherapy

• No prior anticancer radiotherapy

Surgery

• See Disease Characteristics

Other

• No other prior anticancer therapy