Skip to main content
SpringerLink
Log in

Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage III and IV disease

  • RADIOTHERAPY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To compare toxicity, survival and laryngeal preservation rate after radiotherapy alone (RR), radiotherapy after supraglottic horizontal laryngectomy (SHLR) and radiotherapy after total laryngectomy (TLR) for advanced supraglottic laryngeal cancer.

Materials and methods

From 1984 to 2012, 532 patients (pts) were treated in our Department: 273 were potentially fit for conservative surgery (Group I) and 259 were not amenable to partial surgery (Group II).

Results

A younger age (p = 0.005), a better performance status (p < 0.001), the absence of comorbidities (p < 0.001) and the absence of nodal involvement (p = 0.006) favorably impacted on overall survival. More high-grade mucositis (p = 0.009), mild dysphagia (p < 0.001) and mild xerostomia (p < 0.001) were found in RR group; surgical patients had more edema of neck (p = 0.009) and skin toxicity (p = 0.008). Group I No differences in local, nodal and distant recurrences and in number of rescue laryngectomies were observed. The disease characteristics (T, N and stage) but not the treatment modality impacted on disease-free survival (DFS). Group II There was an higher number of local (p = 0.013) and nodal (p = 0.022) recurrences after RR. DFS (p = 0.01) was longer after TLR. No differences in DFS between TLR patients and RR patients who underwent radio-chemotherapy were found.

Conclusion

In Group I, RR results in a local–regional control and organ preservation comparable to surgical treatments, with only slight increase of late mild xerostomia and dysphagia. In Group II RR was less effective than TLR, with a significantly worse DFS. The use of concurrent radical radio-chemotherapy seems to provide comparable loco-regional control to TLR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A (2009) Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 266:1333–1352

    Article  PubMed  Google Scholar 

  2. Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Lustig R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK (2012) Long-term follow-up of the RTOG 9501/Intergroup Phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 84:1198–1205

    Article  PubMed  PubMed Central  Google Scholar 

  3. NCCN practice Guidelines. Head and Neck cancers v2.2014 http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf

  4. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349(22):2091–2098

    Article  PubMed  CAS  Google Scholar 

  5. Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad W, Wagner H, Ensley JF, Cooper JS (2013) Long-term results of RTOG 91–11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 31(7):845–852

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H, Morrison W, Glisson B, Trotti A, Ridge JA, Chao KS, Peters G, Lee DJ, Leaf A, Ensley J (2003) Outcome of salvage total laryngectomy following organ preservation therapy: the radiation therapy oncology group trial 91–11. Arch Otolaryngol Head Neck Surg 129(1):44–49

    Article  PubMed  Google Scholar 

  7. Buglione M, Pedretti S, Costa L et al (2015) Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage I and II disease. Radiol Med 1–7

  8. Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang KK, Clayman GL, Fisher SG, Forastiere AA, Harrison LB, Lefebvre JL, Leupold N, List MA, O’Malley BO, Patel S, Posner MR, Schwartz MA, Wolf GT (2006) American society of clinical oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol 24:3693–3704

    Article  PubMed  Google Scholar 

  9. Rodrigo JP, Coca-Pelaz A, Suárez C (2011) The current role of partial surgery as a strategy for functional preservation in laryngeal carcinoma. Acta Otorrinolaringol Esp 62(3):231–238

    Article  PubMed  Google Scholar 

  10. Sánchez-Cuadrado I, Castro A, Bernáldez R, Del Palacio A, Gavilán J (2011) Oncologic outcomes after supracricoid partial laryngectomy. Otolaryngol Head Neck Surg 144(6):910–914

    Article  PubMed  Google Scholar 

  11. Russi EG, Sanguineti G, Chiesa F, Franco P, Succo G, Merlotti A, Ansarin M, Melano A, Alterio D, Pergolizzi S, Buglione M, Reali A, Ricardi U, Corvò R (2013) Is there a role for postoperative radiotherapy following open partial laryngectomy when prognostic factors on the pathological specimen are unfavourable? A survey of head and neck surgical/radiation oncologists. Acta Otorhinolaryngol Ital 33:311–319

    PubMed  CAS  PubMed Central  Google Scholar 

  12. Mercante G, Grammatica A, Battaglia P, Cristalli G, Pellini R, Spriano G (2013) Supracricoid partial laryngectomy in the management of T3 laryngeal cancer. Otolaryngol Head Neck Surg 149(5):714–720

    Article  PubMed  Google Scholar 

  13. Iro H, Waldfahrer F, Altendorf-Hofmann A, Weidenbecher M, Sauer R, Steiner W (1998) Transoral laser surgery of supraglottic cancer: follow-up of 141 patients. Arch Otolaryngol Head Neck Surg 124:1245–1250

    Article  PubMed  CAS  Google Scholar 

  14. Hinni ML, Salassa JR, Grant DG, Pearson BW, Hayden RE, Martin A, Christiansen H, Haughey BH, Nussenbaum B, Steiner W (2007) Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg 133:1198–1204

    Article  PubMed  Google Scholar 

  15. Rudert HH, Werner JA, Hoft S (1999) Transoral carbon dioxide laser resection of supraglottic carcinoma. Ann Otol Rhinol Laryngol 108:819–827

    Article  PubMed  CAS  Google Scholar 

  16. Grant DG, Salassa JR, Hinni ML, Pearson BW, Hayden RE, Perry WC (2007) Transoral laser microsurgery for carcinoma of the supraglottic larynx. Otolaryngol Head Neck Surg 136:900–906

    Article  PubMed  Google Scholar 

  17. Vilaseca I, Bernal-Sprekelsen M, Luis Blanch J (2010) Transoral laser microsurgery for T3 laryngeal tumors: prognostic factors. Head Neck 32:929–938

    PubMed  Google Scholar 

  18. de Vincentiis M, Minni A, Gallo A, Di Nardo A (1998) Supracricoid partial laryngectomies: oncologic and functional results. Head Neck 20:504–509

    Article  PubMed  CAS  Google Scholar 

  19. Robbins KT, Davidson W, Peters LJ, Goepfert H (1988) Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx. Arch Otolaryngol Head Neck Surg 114:421–426

    Article  PubMed  CAS  Google Scholar 

  20. The Department of Veterans Affairs Laryngeal Cancer Study Group (1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 324:1685–1690

    Article  Google Scholar 

  21. Hong WK, Lippman SM, Wolf GT (1993) Recent advances in head and neck cancer—larynx preservation and cancer chemoprevention: the Seventeenth Annual Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Res 53:5113–5120

    PubMed  CAS  Google Scholar 

  22. Haddad R, O’Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, Clark J, Sarlis N, Lorch J, Beitler JJ, Limaye S, Riley S, Posner M (2013) Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 14:257–264

    Article  PubMed  CAS  Google Scholar 

  23. Cohen EE, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH, Brockstein BE, Agulnik MB, Mittal BB, Yunus F, Samant S, Raez LE, Mehra R, Kumar P, Ondrey F, Marchand P, Braegas B, Seiwert TY, Villaflor VM, Haraf DJ, Vokes EE (2012) De-CIDE: a phase II randomized trial of docetaxel, cisplatin, 5FU induction chemotherapy in patients with N2 N3 locally advanced squamous cell cancer of the head and neck. J Clin Oncol 30(suppl 15):5500

    Google Scholar 

  24. Hanna GJ, Haddad RI, Lorch JH (2013) Induction chemotherapy for locoregionally advanced head and neck cancer: past, present, future? Oncologist 18(3):288–293

    Article  PubMed  PubMed Central  Google Scholar 

  25. Duprez F, Madani I, De Potter B, Boterberg T, De Neve W (2013) Systematic review of dose-volume correlates for structures related to late swallowing disturbances after radiotherapy for head and neck cancer. Dysphagia 28(3):337–349

    Article  PubMed  Google Scholar 

  26. Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, Wirth LJ, Haddad RI, Norris CM, Court LE, Aninno DJ, Posner MR, Allen AM (2008) Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 72:1110–1118

    Article  PubMed  Google Scholar 

  27. Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, Magnuson JS, Spencer SA, Bonner JA (2009) Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 73:410–415

    Article  PubMed  Google Scholar 

  28. Jensen K, Lambertsen K, Grau C (2007) Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol 85:74–82

    Article  PubMed  Google Scholar 

  29. Langendijk JA, Doornaert P, Rietveld DH, Verdonck-de Leeuw IM, Leemans CR, Slotman BJ (2009) A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 90:189–195

    Article  PubMed  Google Scholar 

  30. Nguyen NP, Sallah S, Karlsson U, Antoine JE (2002) Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer 94:1131–1141

    Article  PubMed  Google Scholar 

  31. Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, Marsh R, Pameijer FA, Balm AJ (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60:1425–1439

    Article  PubMed  Google Scholar 

  32. Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJ, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmitz PI, Heijmen BJ (2007) Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol 85:64–73

    Article  PubMed  Google Scholar 

  33. Deantonio L, Masini L, Brambilla M, Pia F, Krengli M (2013) Dysphagia after definitive radiotherapy for head and neck cancer. Correlation of dose-volume parameters of the pharyngeal constrictor muscles. Strahlenther Onkol 189(3):230–236

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology Department, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy

    Loredana Costa, Ludovica Pegurri, Nadia Pasinetti, Sandro Tonoli, Stefano Maria Magrini & Michela Buglione

  2. Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy

    Sara Pedretti, Federica Foscarini, Marta Maddalo, Roberta Cavagnini, Stefano Ciccarelli, Stefano Maria Magrini & Michela Buglione

Authors
  1. Loredana Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Pedretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica Foscarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marta Maddalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ludovica Pegurri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nadia Pasinetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roberta Cavagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefano Ciccarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sandro Tonoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stefano Maria Magrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Michela Buglione
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michela Buglione.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costa, L., Pedretti, S., Foscarini, F. et al. Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage III and IV disease. Radiol med 121, 70–79 (2016). https://doi.org/10.1007/s11547-015-0565-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-015-0565-6

Keywords

Search

Navigation