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Organ-preservation (chemo)radiotherapy for T4 laryngeal and hypopharyngeal cancer: is the effort worth?

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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.

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Funding

None of the authors have received any funding.

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Author notes

  1. Arash Navran and Iris Walraven contributed equally to this work and should be regarded as shared second author.

Authors and Affiliations

  1. Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Abrahim Al-Mamgani, Arash Navran & Iris Walraven

  2. Department of Head and Neck Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Willen Hans Schreuder & Willem Martin C. Klop

  3. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Margot E. T. Tesselaar

Authors
  1. Abrahim Al-Mamgani
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  2. Arash Navran
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  3. Iris Walraven
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  4. Willen Hans Schreuder
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  5. Margot E. T. Tesselaar
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  6. Willem Martin C. Klop
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Corresponding author

Correspondence to Abrahim Al-Mamgani.

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All authors declare no conflict of interest.

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This article does not contain any experimental study with human participants performed by any of the authors. For this type of work, formal consent is not required due to its retrospective nature.

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Al-Mamgani, A., Navran, A., Walraven, I. et al. Organ-preservation (chemo)radiotherapy for T4 laryngeal and hypopharyngeal cancer: is the effort worth?. Eur Arch Otorhinolaryngol 276, 575–583 (2019). https://doi.org/10.1007/s00405-018-5241-8

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  • DOI: https://doi.org/10.1007/s00405-018-5241-8

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