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Impact of indication-shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma

European Archives of Oto-Rhino-Laryngology volume 272, pages 2017–2025 (2015)Cite this article

Abstract

Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III–IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p < 0.01), while the improvement for hypopharyngeal cancer patients was not significant (p < 0.2). After 2004, there was a slight increase (+10.2 %) of primary radiochemotherapy (pRCT) due to stronger selection if R0 > 5 mm-resectability is unlikely. Standardised use of PORCT and pRCT considering clear indications showed to be significantly involved in improved survival in advanced LHSCC.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, University Hospital of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany

    A. Boehm, F. Lindner, G. Wichmann & A. Dietz

  2. Department of Pathology, University of Leipzig, Leipzig, Germany

    U. Bauer & C. Wittekind

  3. University Cancer Center (UCCL), University of Leipzig, Leipzig, Germany

    M. Knoedler & F. Lordick

  4. Department of Radiation Oncology, University of Leipzig, Leipzig, Germany

    S. Dietzsch & R. Kortmann

  5. Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany

    M. Scholz

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  1. A. Boehm
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  2. F. Lindner
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  3. G. Wichmann
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  4. U. Bauer
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  5. C. Wittekind
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  6. M. Knoedler
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  7. F. Lordick
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  8. S. Dietzsch
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  9. M. Scholz
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  10. R. Kortmann
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  11. A. Dietz
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Correspondence to A. Boehm.

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A. Dietz and R. Kortmann have equally contributed to the publication and have shared senior authorship.

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Boehm, A., Lindner, F., Wichmann, G. et al. Impact of indication-shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 272, 2017–2025 (2015). https://doi.org/10.1007/s00405-014-3134-z

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  • DOI: https://doi.org/10.1007/s00405-014-3134-z

Keywords

  • Head neck squamous cell carcinoma
  • Larynx cancer
  • Hypopharynx cancer
  • Treatment outcome
  • Adjuvant chemotherapy
  • Radiation therapy
  • Radio chemotherapy