Abrahim Al-Mamgani1, Arash Navran2, Iris Walraven2, Willen Hans Schreuder3, Margot E T Tesselaar4, Willem Martin C Klop3. 1. Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. a.almamgani@nki.nl. 2. Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 3. Department of Head and Neck Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Abstract
PURPOSE: We aimed to analyze the oncological and functional outcomes of chemoradiation for T4 laryngeal and hypopharyngeal cancer. METHODS: Patients treated between 2008 and 2015 with chemoradiation (n = 39) were retrospectively analyzed for oncological and functional (laryngo-esophageal dysfunction-free survival, LED-FS) outcomes and compared with 32 consecutive patients treated primarily with total laryngectomy (TL). LED was scored as event in case of local failure, TL for any reason, persistent tracheotomy and/or feeding tube dependency 2 years after chemoradiation. RESULTS: The 5-year local control (LC) rates in the chemoradiation and TL groups were 64 and 87%, respectively (p = 0.030). The disease-free survival was 54 and 59% (p = 0.810), and overall survival (OS) was 46 and 47% (p = 1.00). In the chemoradiation group, the 5-year cumulative incidence of LED-FS was 46%, but was significantly worse in patients with poor pre-treatment laryngeal function, compared to those without (20% and 74%, respectively, p = 0.001). Furthermore, patients with LED have significantly worse OS compared to those without (32% and 65%, respectively, p = 0.041). Multivariate analysis showed that primary treatment type is significantly predictive for LC, while tumor site and extra-capsular extension were predictive for OS. Poor pre-treatment laryngeal function is the only significant predictive factor for LED. CONCLUSIONS: TL resulted in significantly better LC, as compared to chemoradiation in T4 laryngeal and hypopharyngeal cancer patients and the LED-FS is worse in patients with poor pre-treatment laryngeal function. These patients might benefit more from primary treatment with TL followed by radiotherapy. These issues should be taken into consideration, as patients are counseled about different primary treatment options.
PURPOSE: We aimed to analyze the oncological and functional outcomes of chemoradiation for T4 laryngeal and hypopharyngeal cancer. METHODS:Patients treated between 2008 and 2015 with chemoradiation (n = 39) were retrospectively analyzed for oncological and functional (laryngo-esophageal dysfunction-free survival, LED-FS) outcomes and compared with 32 consecutive patients treated primarily with total laryngectomy (TL). LED was scored as event in case of local failure, TL for any reason, persistent tracheotomy and/or feeding tube dependency 2 years after chemoradiation. RESULTS: The 5-year local control (LC) rates in the chemoradiation and TL groups were 64 and 87%, respectively (p = 0.030). The disease-free survival was 54 and 59% (p = 0.810), and overall survival (OS) was 46 and 47% (p = 1.00). In the chemoradiation group, the 5-year cumulative incidence of LED-FS was 46%, but was significantly worse in patients with poor pre-treatment laryngeal function, compared to those without (20% and 74%, respectively, p = 0.001). Furthermore, patients with LED have significantly worse OS compared to those without (32% and 65%, respectively, p = 0.041). Multivariate analysis showed that primary treatment type is significantly predictive for LC, while tumor site and extra-capsular extension were predictive for OS. Poor pre-treatment laryngeal function is the only significant predictive factor for LED. CONCLUSIONS: TL resulted in significantly better LC, as compared to chemoradiation in T4 laryngeal and hypopharyngeal cancerpatients and the LED-FS is worse in patients with poor pre-treatment laryngeal function. These patients might benefit more from primary treatment with TL followed by radiotherapy. These issues should be taken into consideration, as patients are counseled about different primary treatment options.
Entities:
Keywords:
Chemoradiation; Hypopharyngeal cancer; Laryngeal cancer; Organ preservation; Total laryngectomy
Authors: Gregory T Wolf; Susan Gross Fisher; Waun Ki Hong; Robert Hillman; Monica Spaulding; George E Laramore; James W Endicott; Kenneth McClatchey; William G Henderson Journal: N Engl J Med Date: 1991-06-13 Impact factor: 91.245
Authors: Arlene A Forastiere; Nofisat Ismaila; Jan S Lewin; Cherie Ann Nathan; David J Adelstein; Avraham Eisbruch; Gail Fass; Susan G Fisher; Scott A Laurie; Quynh-Thu Le; Bernard O'Malley; William M Mendenhall; Snehal Patel; David G Pfister; Anthony F Provenzano; Randy Weber; Gregory S Weinstein; Gregory T Wolf Journal: J Clin Oncol Date: 2017-11-27 Impact factor: 44.544
Authors: Serena A Byrd; Mary J Xu; Lauren M Cass; Daniel J Wehrmann; Matthew Naunheim; Kara Christopher; John J Dombrowski; Ronald J Walker; Lori Wirth; John Clark; Paul Busse; Annie Chan; Daniel G Deschler; Kevin Emerick; Derrick T Lin; Mark A Varvares Journal: Oral Oncol Date: 2018-02-20 Impact factor: 5.337
Authors: Surbhi Grover; Samuel Swisher-McClure; Nandita Mitra; Jiaqi Li; Roger B Cohen; Peter H Ahn; John N Lukens; Ara A Chalian; Gregory S Weinstein; Bert W O'Malley; Alexander Lin Journal: Int J Radiat Oncol Biol Phys Date: 2015-07-01 Impact factor: 7.038
Authors: Jeffrey E Terrell; David L Ronis; Karen E Fowler; Carol R Bradford; Douglas B Chepeha; Mark E Prince; Theodoros N Teknos; Gregory T Wolf; Sonia A Duffy Journal: Arch Otolaryngol Head Neck Surg Date: 2004-04
Authors: David J Adelstein; Yi Li; George L Adams; Henry Wagner; Julie A Kish; John F Ensley; David E Schuller; Arlene A Forastiere Journal: J Clin Oncol Date: 2003-01-01 Impact factor: 44.544
Authors: Lilian N Ruiter; Boukje A C van Dijk; Annette H Bruggink; Patricia A H Doornaert; Marielle E P Philippens; Remco de Bree; Carla H van Gils; Stefan M Willems Journal: BMC Cancer Date: 2022-04-22 Impact factor: 4.638
Authors: Coralie R Arends; Japke F Petersen; Vincent van der Noort; Adriana J Timmermans; C René Leemans; Remco de Bree; Michiel W M van den Brekel; Martijn M Stuiver Journal: Laryngoscope Date: 2019-11-06 Impact factor: 3.325