European Archives of Oto-Rhino-Laryngology

, Volume 265, Issue 10, pp 1245–1255

The impact of treatment center on the outcome of patients with laryngeal cancer treated with surgery and radiotherapy

Authors

    • Department of Radiation Oncology, Medical SchoolDokuz Eylül University
  • Nihal Dag
    • Department of Radiation Oncology, Medical SchoolDokuz Eylül University
  • Ozlem Uruk Ataman
    • Department of Radiation Oncology, Medical SchoolDokuz Eylül University
  • Cenk Ecevit
    • Department of Head and Neck Surgery, Medical SchoolDokuz Eylül University
  • Ahmet Omer Ikiz
    • Department of Head and Neck Surgery, Medical SchoolDokuz Eylül University
  • Isin Arslan
    • Department of Radiation Oncology, Medical SchoolDokuz Eylül University
  • Sulen Sarıoglu
    • Department of Pathology, Medical SchoolDokuz Eylül University
  • Emel Ada
    • Department of Radiology, Medical SchoolDokuz Eylül University
  • Munir Kinay
    • Department of Radiation Oncology, Medical SchoolDokuz Eylül University
  • Dokuz Eylül Head and Neck Tumour Group (DEHNTG)
Head and Neck

DOI: 10.1007/s00405-008-0664-2

Cite this article as:
Akman, F.C., Dag, N., Ataman, O.U. et al. Eur Arch Otorhinolaryngol (2008) 265: 1245. doi:10.1007/s00405-008-0664-2

Abstract

For laryngeal cancer, surgical excision of the primary tumor should be undertaken with the aim of achieving tumor-free margins. Adequate pathological assessment of the specimen and the competency of the treatment center play a crucial role in achieving cure. The present study aimed to analyze the significance of place of surgery on the outcome of patients with laryngeal cancer who underwent surgical operation in other centers and were subsequently referred to Doküz Eylul University Head and Neck Tumour Group (DEHNTG) for postoperative irradiation. Patients were divided into three groups according to their place of surgery. The first group (Group I) consisted of patients who had their surgical operation at DEUH. Patients in the second group (Group II) were referred from centers with oncological surgical experience. The third group (Group III) consisted of patients referred from hospitals with no surgical teams experienced in head and neck cancer treatment. The clinical and pathological features of patients in these three groups were analyzed to assess the impact of place of surgery on clinical outcome as well as the prognostic factors for survival. The study population consisted of 253 patients who were treated between 1991 and 2006 with locally advanced laryngeal cancer according to the protocol of DEHNTG. The median follow-up was 48 (3–181) months. The 5 years overall, loco-regional disease-free and distant disease-free survivals were 66, 88 and 91%, respectively. When patients’ clinical and histopathological features were analyzed for the impact of place of surgery, surgical margin positivity rates were found to be higher in Group III (P = 0.032), although the other two groups had more advanced clinical and pathological N stage disease (P = 0.012, P = 0.001). In multivariate analysis, older age (P < 0.0001), presence of perinodal invasion (P = 0.012), time interval between surgery and radiotherapy longer than 6 weeks (P = 0.003) and tumor grade (P = 0.049) were the most significant factors. For loco-regional failure-free survival, advanced clinical stage (P = 0.002), place of surgery (P = 0.031) and presence of clinical subglottic invasion (P = 0.029) were shown to be important prognostic factors. For distant metastasis-free survival, only pathological (+) lymph node status (P = 0.046) was a significant factor in multivariate analysis. The significance of place of surgery as well as other well-known prognostic factors underlines the importance of an experienced multidisciplinary treatment team if best results are to be obtained for the patient.

Keywords

Larynx cancerRadiotherapySurgeryPrognostic factorsSurvival

Copyright information

© Springer-Verlag 2008