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Management of loco-regionally advanced squamous laryngeal cancer in elderly patients

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Abstract

Purpose

To describe the management and outcomes of loco-regionally advanced (stages III-IV) laryngeal cancer (LRALC) in elderly patients.

Methods

Clinical records of 88 LRALC patients treated at our Institution from 2002 to 2017 were retrospectively reviewed. Patients were divided in 2 subgroups: age > 65 years (elderly) and age ≤ 65 years (controls). Survivals were estimated with Kaplan–Meier method and compared with log-rank test, multivariate analysis were performed with Cox proportional hazard methods.

Results

Eighty-eight LRALC patients were included: 45 elderly and 43 controls. Median follow-up was 55.3 months. Median age was 66 years (range 41–84) in the overall population, 72 years (range 66–84) in the elderly cohort. The majority (98%) of elderly patients had at least one comorbidity (ACE27 1–3), while ACE27 was 0 in 37% of controls (p = 0.0001). ECOG PS was 0 in 42% of elderly vs 79% of controls (p = 0.0029). Clinical stage (TNM eighth edition) was III in 67%, IVA in 22% and IVB in 11%. Treatment consisted in total laryngectomy (TL) in 55%, chemo-radiation in 29%, exclusive radiotherapy in 9%, and conservative surgery in 7%. In elderly patients 2-year disease-free and overall survivals were 58% and 74%, respectively. Multivariate analysis performed on the overall group of 88 patients showed that age (HR 1.07, p = 0.0006) and TNM (for both 7th and 8th Editions HR 0.27 for stage III vs IV, p = 0.0005) maintained an independent statistical significant association with OS.

Conclusions

In this monocentric cohort, age and TNM confirmed their independent prognostic role in LRALC patients. Organ-preservation is still an unmet need in a significant portion of elderly patients.

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Authors and Affiliations

  1. Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy

    Stefano Cavalieri, Cristiana Bergamini, Salvatore Alfieri, Carlo Resteghini, Francesca Platini, Giulia Apollonio, Teresa Beninato, Lisa Licitra & Laura Deborah Locati

  2. Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy

    Ester Orlandi, Eliana Ivaldi, Nicola Alessandro Iacovelli & Rossana Ingargiola

  3. Maxillofacial and Thyroid Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy

    Fabiola Incandela, Walter Fontanella, Lorenzo Bresciani, Lorenzo Giannini & Cesare Piazza

  4. Department of Oncology and Oncohaematology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy

    Cesare Piazza & Lisa Licitra

Authors
  1. Stefano Cavalieri
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  18. Laura Deborah Locati
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Corresponding author

Correspondence to Stefano Cavalieri.

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Conflict of Interest

L.D.L.: grant and other financial relationship with Biogen, Eisai, Ipsen, Lilly, Merck Serono, MSD and BMS.L.L. has received funding (for her Institution) for clinical studies and research from AstraZeneca, Boehringer Ingelheim, Eisai, Merck Serono, MSD, Novartis, and Roche; has received compensation for service as a consultant/advisor and/or for lectures from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Debiopharm, Eisai, Merck Serono, MSD, Novartis, Roche, and Sobi; she has received travel coverage for medical meetings from Bayer, Bristol-Myers Squibb, Debiopharm, Merck Serono, MSD, and Sobi.The remaining authors declare no conflict of interest.

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Cavalieri, S., Orlandi, E., Ivaldi, E. et al. Management of loco-regionally advanced squamous laryngeal cancer in elderly patients. Eur Arch Otorhinolaryngol 278, 771–779 (2021). https://doi.org/10.1007/s00405-020-06179-1

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  • DOI: https://doi.org/10.1007/s00405-020-06179-1

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