European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 3, pp 547–554 | Cite as

Survival outcome depending on different treatment strategies in advanced stages III and IV laryngeal cancers: an audit of data from two European centres

  • Therese R. Karlsson
  • Mohammed Al-Azzawe
  • Luaay Aziz
  • David Hurman
  • Caterina Finizia


In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.


Laryngeal neoplasm Radiotherapy Laryngectomy Survival Advanced disease 



The authors would like to thank Erik Holmberg at the Regionalt Cancer Centrum Väst for his help with statistical analysis. This study was supported by the Swedish Cancer Society, the Research and Development Council, Västra Götaland (Sweden) County and the Medical Faculty of Gothenburg University Sweden.

Conflict of Interest



  1. 1.
    Chu EA, Kim YJ (1998) Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin North Am 41:673–695CrossRefGoogle Scholar
  2. 2.
    Globocan (2008) Cancer incidence and mortality worldwide. IARC CancerBase No 10. Cited 2012 April 2Google Scholar
  3. 3. Cancer incidence in Sweden (2012) Accessed on 22 Apr 2012
  4. 4.
    Oncologiskt Centrum Västra Sjukvårdsregionen. Regionalt Vårdprogram/Riktlinjer 2011 Huvud-halscancer. Accessed on 1 Aug 2012
  5. 5.
    Lubin JH, Purdue M, Kelsey K, Zann ZF, Winn D, Wei Q et al (2009) Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case–control studies. Am J Epidemiol 170(8):937–947PubMedCrossRefGoogle Scholar
  6. 6.
    Johansson M (2010) Mental adjustment and health-related quality of life in laryngeal cancer patients: quantitative and qualitative approaches. ThesisGoogle Scholar
  7. 7.
    Rothman KJ, Cann CI, Flanders D, Fried MP (1980) Epidemiology of laryngeal cancer. Epidemiol Rev 2:195–209PubMedGoogle Scholar
  8. 8.
    Souhami R, Tobias J (1986) Cancer and its management, 2nd edn. Blackwell Science Ltd, Oxford, pp 175–179Google Scholar
  9. 9.
    Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang K et al (2006) American society of clinical oncology clinical practice guidelines for the use of larynx-preserving strategies in the treatment of laryngeal cancer. J Clin Oncol 24:3693–3704PubMedCrossRefGoogle Scholar
  10. 10.
    Mendenhall WM, Amdur RJ (2001) Treatment of laryngeal cancer. J HK Coll Radiol 4:116–118Google Scholar
  11. 11.
    Morris MR, Canonico D, Blank C (1994) A critical review of radiotherapy in the management of T1 glottic carcinoma. Am J Otolaryngol 15:276–280PubMedCrossRefGoogle Scholar
  12. 12.
    Scottish Intercollegiate Guidelines Network (2006) Diagnosis and management of head and neck cancer: A national clinical guideline (90). Scottish Intercollegiate Guidelines Network, EdinburghGoogle Scholar
  13. 13.
    Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH (2004) Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope 114:1438–1446PubMedCrossRefGoogle Scholar
  14. 14.
    Corry J, Rischin D, Cotton S, D’Costa I, Chua M, Vallance N et al (2011) Larynx preservation with primary non-surgical treatment for loco-regionally advanced larynx cancer. J Med Imag Radiat On 55:229–235CrossRefGoogle Scholar
  15. 15.
    Hinerman R, Mendenhall W, Morris CG, Amdur R, Werning J, Villaret D (2007) T3 and T4 true vocal cord squamous carcinoma treated with external beam irradiation: a single institution’s 35-year experience. Am J Clin Oncol 30(2):181–185PubMedCrossRefGoogle Scholar
  16. 16.
    Haugen H, Johansson K-A, Ejnell H, Edström S, Mercke C (2005) Accelerated radiotherapy for advanced laryngeal cancer. Acta Oncol 44(5):481–489PubMedCrossRefGoogle Scholar
  17. 17.
    Dey P, Arnold D, Wight R, Kelly CG, McKenzie K (2002) Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell carcinoma. Cochrane Database of Syst Rev 2:CD002027Google Scholar
  18. 18.
    Hartl DM, Ferlito A, Brasnu DF, Langendijk JA, Rinaldo A, Silver CE et al (2011) Evidence-based review of treatment options for patients with glottic cancer. Head Neck 33:1638–1648PubMedCrossRefGoogle Scholar
  19. 19.
    Sessions DG, Lenox J, Spector GJ, Newland D, Simpson J, Haughey BH et al (2002) Management of T3N0M0 Glottic Carcinoma; Therapeutic Outcomes. Laryngoscope 112:1281–1288PubMedCrossRefGoogle Scholar
  20. 20.
    MacKenzie RG, Franssen E, Balogh JM, Gilbert RW, Birt D, Davidson J (2000) Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for sugery. Int J Radiat Oncol Biol Phys 47(1):65–71PubMedCrossRefGoogle Scholar
  21. 21.
    Spector JG, Sessions DG, Lenox J, Simpson J (2006) Management of T3N1 glottic carcinoma: therapeutic outcomes. Laryngoscope 116:106–110PubMedCrossRefGoogle Scholar
  22. 22.
    Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952PubMedCrossRefGoogle Scholar
  23. 23.
    Cooper JS, Pajak TF, Forastiere AA et al (2004) Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous cell carcinoma of the head and neck. N Engl J Med 350:1937–1944PubMedCrossRefGoogle Scholar
  24. 24.
    Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saman SB, et al. (2012) Long-tern 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. doi: 10.1016/j.ijrobp.2012.05.008
  25. 25.
    Forastiere AA, Goepfert H, Maor M, Pajak T, Weber R, Morrison W et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349(22):2091–2098PubMedCrossRefGoogle Scholar
  26. 26.
    Wolf GT; 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 324:1685–1690CrossRefGoogle Scholar
  27. 27.
    Sessions DG, Lenox J, Spector DJ (2005) Supraglottic laryngeal cancer: analysis of treatment results. Laryngoscope 115:1402–1410PubMedCrossRefGoogle Scholar
  28. 28.
    Rades D, Schroeder U, Bajrovic A, Schild SE (2011) Radiochemotherapy versus surgery plus radio(chemo)therapy for stage T3/T4 larynx and hypopharynx cancer—results of matched-pair analysis. Eur J Cancer 47:2729–2734PubMedCrossRefGoogle Scholar
  29. 29.
    Chen AY, Halpern M (2007) Factors predictive of survival in advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg 133(12):1270–1276PubMedCrossRefGoogle Scholar
  30. 30.
    Gourin CG, Conger BT, Sheils C, Bilodeau PA, Coleman TA, Porubsky ES (2009) The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope 119:1312–1317PubMedCrossRefGoogle Scholar
  31. 31.
    Patel UA, Howell LK (2011) Local response to chemoradiation in T4 larynx cancer with cartilage invasion. Laryngoscope 121:106–110PubMedCrossRefGoogle Scholar
  32. 32.
    Finizia C, Geterud Å, Holmberg E, Lindström J, Lundgren J (1996) Advanced laryngeal cancer T3-T4 in Sweden: a retrospective study 1986-1990. Survival and locoregional control related to treatment. Acta Otolaryngol 116(6):906–912PubMedCrossRefGoogle Scholar
  33. 33.
    Fung K, Lyden TH, Lee J, Urba SG, Worden F, Eisbrusch A, Tsien C et al (2005) Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. Int J Radiat Oncol Biol Phys 63(5):1395–1399PubMedCrossRefGoogle Scholar
  34. 34.
    Finizia C, Bergman B (2001) Health-related quality of life in patients with laryngeal cancer: a post-treatment comparison of different modes of communication. Laryngoscope 111:918–923PubMedCrossRefGoogle Scholar
  35. 35.
    Rudolph E, Dyckhoff G, Becher H, Dietz A, Ramroth H (2011) Effects of tumour stage, comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis. Eur Arch Otorhinolaryngol 268:165–179PubMedCrossRefGoogle Scholar
  36. 36.
    Hu M, Ampil F, Clark C, Sonavane K, Caldito G, Nathan CA (2012) Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma. Laryngoscope 122:565–571PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Therese R. Karlsson
    • 1
  • Mohammed Al-Azzawe
    • 1
  • Luaay Aziz
    • 1
  • David Hurman
    • 2
  • Caterina Finizia
    • 1
  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery Sahlgrenska University HospitalGothenburg UniversityGothenburgSweden
  2. 2.Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK

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