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Tassler AB, Gooding WE, Ferris RL. Hypopharyngeal cancer treatment: Does initial surgery confer survival benefit? Head Neck 2019; 41:2167-2173. [PMID: 30779398 PMCID: PMC7723819 DOI: 10.1002/hed.25687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Organ preservation protocols have increasingly been applied for the treatment of head and neck cancers, including hypopharyngeal squamous cell carcinoma (HSCC). We sought to evaluate whether patients treated with primary surgery followed by adjuvant therapy had survival benefit over patients treated with initial nonsurgical modalities. METHODS We retrospectively reviewed patients with new diagnosis of HSCC at the University of Pittsburgh (1994-2014) treated with either primary total laryngectomy with pharyngectomy or organ preservation. RESULTS One hundred thirty-seven patients were identified. Surgical cases were more likely to be of advanced T stage. Initial surgery was more likely to be performed in the earlier years of the cohort. After adjusting for this imbalance using a propensity score, primary surgery was associated with improved survival compared with nonoperative therapy (P = 0.02). CONCLUSIONS Due to its survival advantage, primary surgery followed by adjuvant treatment should be considered as a viable treatment of HSCC.
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Affiliation(s)
- Andrew B. Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - William E. Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Robert L. Ferris
- Department of Otolaryngology and Immunology, University of Pittsburgh Medical Center and Cancer Institute, Pittsburgh, Pennsylvania
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Kim SY, Rho YS, Choi EC, Kim MS, Woo JH, Lee DH, Chung EJ, Park MW, Kim DH, Joo YH. Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer. BMC Cancer 2017; 17:904. [PMID: 29284434 PMCID: PMC5747182 DOI: 10.1186/s12885-017-3880-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/07/2017] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer. Methods The present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy. Results Five-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS. Conclusion Margin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.
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Affiliation(s)
- Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Chang Choi
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Hyun Woo
- Department of Otolaryngology Head and Neck Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Eun Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Da-Hee Kim
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Department of Otolaryngology, Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon, Kyounggi-do, 420-717, Republic of Korea.
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Scherl C, Mantsopoulos K, Semrau S, Fietkau R, Kapsreiter M, Koch M, Traxdorf M, Grundtner P, Iro H. Management of advanced hypopharyngeal and laryngeal cancer with and without cartilage invasion. Auris Nasus Larynx 2017; 44:333-339. [DOI: 10.1016/j.anl.2016.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 12/16/2022]
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Patel UA, Howell LK. Local response to chemoradiation in T4 larynx cancer with cartilage invasion. Laryngoscope 2011; 121:106-10. [PMID: 21120838 DOI: 10.1002/lary.21181] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with cartilage invasion were excluded from organ preservation protocols treating laryngeal and hypopharyngeal cancer. Treatment choice between chemoradiotherapy (CRT) and total laryngectomy (TL) remains controversial for these patients. OBJECTIVE To assess local response and local recurrence after CRT for patients having T4 larynx or hypopharynx cancer with cartilage invasion. DESIGN Retrospective intervention study. SETTING : Tertiary-care, urban public hospital. PATIENTS Patients with T4 squamous cell carcinoma of the larynx/hypopharynx with cartilage invasion treated from 2003 to 2009. INTERVENTION Curative-intent CRT, compared to TL. OUTCOME MEASURES Local response and local recurrence. RESULTS Of 34 patients included in this study, 21 completed CRT and 13 underwent TL with postoperative RT or CRT. With CRT, 19 patients were noted to have a complete response at the primary site while two patients had persistent local disease. Of 19 patients with complete response, 4 developed local recurrence over a time period 76-226 days (mean: 177 days). This resulted in a 29% incidence of persistent/recurrent disease at the primary site. The remaining 15 patients (71%) remained free of local disease (mean follow-up: 369 days). For 13 patients undergoing TL with adjuvant therapy, there were no cases of local recurrence (mean follow-up: 389 days). CONCLUSIONS Although there was a high initial complete response rate after CRT, this response was not durable with a high local recurrence rate within 1 year. In comparison, patients undergoing TL demonstrated markedly better local control. For patients with cartilage invasion, a prospective trial comparing medical versus surgical therapy is needed.
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Affiliation(s)
- Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
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5
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Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope 2009; 119:2124-34. [DOI: 10.1002/lary.20619] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gourin CG, Conger BT, Sheils WC, Bilodeau PA, Coleman TA, Porubsky ES. The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope 2009; 119:1312-7. [PMID: 19444887 DOI: 10.1002/lary.20477] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer. METHODS Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed. RESULTS A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I-III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1-T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival. CONCLUSIONS Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease.
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Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
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van der Putten L, van den Broek GB, de Bree R, van den Brekel MWM, Balm AJM, Hoebers FJP, Doornaert P, Leemans CR, Rasch CRN. Effectiveness of salvage selective and modified radical neck dissection for regional pathologic lymphadenopathy after chemoradiation. Head Neck 2009; 31:593-603. [PMID: 19132716 DOI: 10.1002/hed.20987] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lisa van der Putten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Bhalavat RL, Fakih AR, Mistry RC, Mahantshetty U. Radical radiation vs surgery plus post-operative radiation in advanced (resectable) supraglottic larynx and pyriform sinus cancers: a prospective randomized study. Eur J Surg Oncol 2003; 29:750-6. [PMID: 14602495 DOI: 10.1016/s0748-7983(03)00072-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Survival in head and neck cancers reflect loco-regional control. With an aim of organ and function preservation the present study was undertaken to compare local failure and survivals. MATERIAL AND METHODS Between August 1991-December 1995, 72 patients with resectable advanced supraglottic cancers, were randomized to radical surgery followed by post-operative radiation therapy (Sx+PORT) (Arm I) or radical radiation therapy followed by salvage surgery (RRT+/-SSx) (Arm II). RESULTS Sixty-four of 72 patients were evaluable, 55 were T3 (86%) and 9 were T4 (14%) tumors. In Arm I (n=35) with a mean follow-up of 24 months (2-86 months), 21 patients were alive without disease. Six patients had recurrence, one each at local and tracheostomy stoma, four had nodal recurrence only, and two developed 2nd primary in soft palate/tonsil and parotid at 15 and 18 months respectively. In Arm II (n=29), with a mean follow-up of 24 months (3-81 months), 14 patients were alive without disease. Thirteen patients had recurrence, eight had local (one patient had persistent disease), two nodal only, three loco-regional and two patients developed distant metastasis (lung). One out of eight local recurrence and 2/2 nodal recurrences were salvaged with Sx. There was a significant difference in disease-free survival between the two treatment arms, DFS (5 years) of 70% in Arm I vs 50% in Arm II (p=0.04), but did not have any impact on overall survival OAS (5 years); 73% vs 77% (p=0.79). Voice/laryngeal preservation was possible in 18/29 patients (62%) treated with RRT+/- Sx, without significantly affecting the OAS. "Pathological upstaging" was another significant finding seen in 64% of clinical T3 after radical surgery. CONCLUSION RRT+/-SSx can be a feasible option in low volume, favourable resectable stage III and IV supraglottic lesions for better quality of life.
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Affiliation(s)
- R L Bhalavat
- Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Mumbai 400012, India.
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Nguyen-Tan PF, Le QT, Quivey JM, Singer M, Terris DJ, Goffinet DR, Fu KK. Treatment results and prognostic factors of advanced T3--4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience. Int J Radiat Oncol Biol Phys 2001; 50:1172-80. [PMID: 11483326 DOI: 10.1016/s0360-3016(01)01538-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To review the UCSF-SUH experience in the treatment of advanced T3--4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival. METHODS AND MATERIALS We reviewed the records of 223 patients treated for T3--4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28--85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan--Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC. RESULTS The median follow-up was 41 months (range, 2--367 months) for all patients and 78 months (range, 6--332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT. CONCLUSION Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels > or = 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- California/epidemiology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant/adverse effects
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Follow-Up Studies
- Hemoglobins/analysis
- Humans
- Laryngeal Neoplasms/drug therapy
- Laryngeal Neoplasms/mortality
- Laryngeal Neoplasms/pathology
- Laryngeal Neoplasms/radiotherapy
- Laryngeal Neoplasms/surgery
- Laryngeal Neoplasms/therapy
- Laryngectomy/adverse effects
- Life Tables
- Male
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary/epidemiology
- Radiotherapy, Adjuvant/adverse effects
- Remission Induction
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- P F Nguyen-Tan
- Department of Radiation Oncology, University of California, San Francisco, CA, USA.
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Abstract
Several altered fractionation schemes have evolved to exploit different aspects of head and neck cancer growth kinetics and normal tissue repair. Hyperfractionation schedules exploit the differential repair abilities of tumor and normal tissue, whereas accelerated fractionation regimens minimize the time of tumor repopulation. Significant clinical data have accumulated that indicate an improvement between 15% and 20% in locoregional control from altered fractionation. Preliminary analysis of a randomized Radiation Therapy Oncology Group trial testing four fractionation schemes confirms the benefit of one altered fractionation approach. Several promising concurrent chemoradiation treatments involving altered fractionation have been reported. Future trials will determine whether the addition of chemotherapy to altered fractionation schemes is warranted in light of the factor of added toxicity.
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Affiliation(s)
- K S Hu
- The Charles and Bernice Blitman Department of Radiation Oncology, Beth Israel Medical Center, 10 Union Square East, New York, NY 10003, USA
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12
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Dawson LA, Lawrence T. Radiation as an Adjunct to Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rudat V, Wannenmacher M. Role of multimodal treatment in oropharynx, larynx, and hypopharynx cancer. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:66-74. [PMID: 11291134 DOI: 10.1002/ssu.1018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to recent advances in radiation fractionation, radiochemotherapy, and conservative surgical techniques, the concept of multimodal therapy in head and neck cancer is currently changing. The recently published RTOG Phase III trial 9003, with 1,113 patients accrued, showed that hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally-advanced head and neck cancer. Acute, but not late, toxicity was also increased. Three meta-analyses have suggested that the impact of chemotherapy in head and neck cancer is small but is highly associated with the timing of therapy. Concomitant administration of radiation therapy and chemotherapy led to an absolute benefit in 5-year survival of about 10%. This finding has been further supported by recently published randomized prospective trials comparing concomitant radiochemotherapy with radiotherapy alone in advanced head and neck cancer. There is now clear evidence that radiochemotherapy provides a substantial and statistically significant improvement in survival and local-regional control, as compared to radiotherapy alone. Radiochemotherapy should be considered an accepted standard of care in cancers of the oropharynx, particularly for patients with locally-advanced disease who have a good performance status. Two randomized studies conducted by the Department of Veterans' Affairs and the EORTC, with a total of 534 patients accrued, showed that induction chemotherapy followed by radiotherapy of responders yields survival rates equal to those of total laryngectomy with postoperative radiotherapy. After 4 years, one-half to two-thirds of survivors of the chemotherapy arm retained a functional larynx. Larynx preservation using induction chemotherapy can now be regarded as feasible but still investigational. Current phase II studies show excellent larynx preservation rates using a primary concomitant radiochemotherapy with an altered fractionation regimen. More clinical and laboratory research is required to further evaluate the different treatment options of the multimodality concept, and to develop prognostic models that will allow individualization of the therapy.
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Affiliation(s)
- V Rudat
- Department of Radiation Oncology, University of Heidelberg, Germany.
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MacKenzie RG, Franssen E, Balogh JM, Gilbert RW, Birt D, Davidson J. Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery. Int J Radiat Oncol Biol Phys 2000; 47:65-71. [PMID: 10758306 DOI: 10.1016/s0360-3016(00)00415-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The use of radical radiotherapy and surgery for salvage (RRSS) in locally advanced squamous cell carcinoma (SCC) of the larynx is controversial. In the absence of randomized studies, it is unclear if RRSS can match the rates of locoregional control and survival reported for primary surgery in this setting. The aim of this study was to compare treatment outcomes of radiotherapy and surgery in comparable patients with CS III-IV SCC of the larynx. METHODS AND MATERIALS Eighty-two patients with untreated T2N+M0 or T3T4NM0 SCC of the larynx were treated with a policy RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990. The medical records at presentation were reviewed independently by a panel of three surgical oncologists blinded as to treatment outcome to determine patient suitability for laryngectomy and neck dissection using eligibility criteria adopted by recent clinical trials. Treatment outcomes for surgery-eligible patients were compared to results of comparably staged patients in the surgical literature since 1980. RESULTS Sixty-three patients (77%) were eligible for study. With a median follow-up of 3 years, radiotherapy controlled the primary in 8/20 evaluable glottic primaries and 21/41 evaluable supraglottic primaries. Forty-five percent of patients surviving 5 years retained a functional larynx. Sixteen of 29 relapsing patients were salvaged with surgery. Disease above the clavicles was controlled in 65% of T3T4N0N+ glottic primaries (compared to a published range of 53% to 79%) and 82% of T3N0 glottic primaries (compared to a published range of 69% to 84%). The 5-year overall survival of patients with T3T4 glottic cancer was 54% compared to a published range of 50% to 63%. The cause-specific survival (CSS) of patients with T3N0 glottic primaries (86% at 1 year and 73% at 2 years) was identical to the only published report of CSS in the surgical literature. CONCLUSION A policy of RRSS offers a good chance of laryngeal conservation without compromising ultimate locoregional control or survival when compared to primary laryngectomy and neck dissection in patients with locally advanced carcinoma of the larynx meeting the surgical eligibility of clinical trials.
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Affiliation(s)
- R G MacKenzie
- Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook and Women's College Health Science Centre, University of Toronto, Toronto, Ontario, Canada.
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15
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Gillison ML, Forastiere AA. Larynx preservation in head and neck cancers. A discussion of the National Comprehensive Cancer Network Practice Guidelines. Hematol Oncol Clin North Am 1999; 13:699-718, vi. [PMID: 10494508 DOI: 10.1016/s0889-8588(05)70087-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The management of advanced cancers of the larynx and hypopharynx has become increasingly complex as different treatment modalities, including surgery, radiation, and chemotherapy, have been combined with the goal of improving local disease control and disease-specific survival. A union of 17 comprehensive cancer centers in the United States, the National Comprehensive Care Network (NCCN), was formed in 1995 to promote state-of-the-art cancer care. To achieve this goal, multidisciplinary panels of experts from member institutions have created disease-specific practice guidelines for the evaluation and treatment of cancer patients, including those with head and neck cancers. Although detailed analysis of surgical methods and radiation techniques are beyond the scope of this article, the evolving laryngeal preservation strategies for patients with advanced, resectable hypopharyngeal or laryngeal (including supraglottic and glottic) cancers are reviewed using relevant sections of the NCCN practice guidelines as a framework for discussion.
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Affiliation(s)
- M L Gillison
- Department of Medical Oncology, Johns Hopkins Oncology Center, Baltimore, Maryland, USA
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