Abstract
The 5-year overall survival (OS) of loco-regionally advanced laryngeal and hypopharyngeal carcinoma (LA-LHC) has declined over the past two decades following the wide application of non-surgical approaches. We aimed to define the new role of open surgery combined with adjuvant chemoradiotherapy in the treatment of LA-LHC for improving survival while maintaining a functional larynx. In the current study, 90 LA-LHC patients treated with open surgery followed by postoperative RT/CRT in our institute from May 2005 to December 2012 were retrospectively analyzed. OS, disease-free survival (DFS), loco-regional failure-free survival (LRFFS) and distant metastasis-free survival (DMFS) were calculated, and prognostic factors were analyzed. Functional larynx preservation results were evaluated according to the head and neck quality of life (QoL) Scale. With a median follow-up period of 37 months, the 3- and 5-year OS, DFS, LRFFS and DMFS were 71.3, 63.7, 85.9, 73.7 and 55.9, 53.0, 81.6, 71.9 %, respectively. Vascular embolism and extracapsular extension (ECE) of the lymph nodes were prognostic factors for poorer OS (p = 0.045 and 0.046, respectively). Vascular embolism was the only prognostic factor for poorer DMFS (p = 0.005). Patients who underwent a conservative partial laryngectomy (CPL) experienced a higher QoL in the domains of speech, swallowing and emotion. Functional larynx preservation was achieved in 36/45 patients (80 %) who received CPL. The results of our study demonstrated that CPL followed by adequate adjuvant therapy could achieve superior oncological results compared with non-surgical approaches in LA-LHC patients while also maintaining satisfactory functional larynx in a majority of patients.
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Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of Worldwide Burden of Cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.
Cooper JS, Porter K, Mallin K, et al. National cancer database report on cancer of the head and neck: 10-year update. Head Neck. 2009;31(6):748–58.
National Comprehensive Cancer Network. Clinical practice guidelines in head and neck cancers. 2014. www.nccn.org. Accessed 30 May 2014.
The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685–90.
Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European organization for research and treatment of cancer phase III Trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996;88(13):890–9.
Lefebvre JL, Andry G, Chevalier D, et al. Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Ann Oncol. 2012;23(10):2708–14.
Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8.
Forastiere AA, Zhang Q, Weber RS, et al. 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. 2013;31(7):845–52.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. Ca-Cancer J Clin. 2014;64(1):9–29.
Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope. 2006;116111(92):1–13.
SEER Cancer Statistics Review, 1975–2010. 2013. http://seer.cancer.gov/csr/1975_2010/. Accessed April 2013.
Pfister DG, Laurie SA, Weinstein GS, et al. American society of clinical oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol. 2006;24(22):3693–704.
Richard JM, Sancho-Garnier H, Pessey JJ, et al. Randomized trial of induction chemotherapy in larynx carcinoma. Oral Oncol. 1998;34(3):224–8.
Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34(2):270–81.
Wang YL, Feng SH, Zhu J, et al. Impact of lymph node ratio on the survival of patients with hypopharyngeal squamous cell carcinoma: a population-based analysis. PLoS ONE. 2013;8(2):e56613.
Genden EM, Ferlito A, Rinaldo A, et al. Recent changes in the treatment of patients with advanced laryngeal cancer. Head Neck J Sci Spec. 2008;30(1):103–10.
Terrell JE, Nanavati KA, Esclamado RM, Bishop JK, Bradford CR, Wolf GT. Head and neck cancer-specific quality of life—instrument validation. Arch Otolaryngol. 1997;123(10):1125–32.
Ware JE. SF-36 health survey: manual and interpretation guide, Boston: Health Institute; 1993.
Lefebvre JL, Rolland F, Tesselaar M, et al. Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy. J Natl Cancer I. 2009;101(3):142–52.
Calais G, Pointreau Y, Alfonsi M, Sire C, Tuchais C, Tortochaux J, Guerif S. Induction chemotherapy for larynx preservation. updated results of the GORTEC 2000-01 randomized trial comparing docetaxel plus cisplatinum plus fluorouracil (TPF) versus cisplatinum plus fluorouracil (PF). EJC Suppl. 2007;5(4):324.
Posner MR, Norris CM, Wirth LJ, et al. Sequential therapy for the locally advanced larynx and hypopharynx cancer subgroup in TAX 324: survival, surgery, and organ preservation. Ann Oncol. 2009;20(5):921–7.
Lefebvre JL, Pointreau Y, Rolland F, et al. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II Study. J Clin Oncol. 2013;31(7):853–9.
Dufour X, Hans S, De Mones E, Brasnu D, Menard M, Laccourreye O. Local control after supracricoid partial laryngectomy for “advanced” endolaryngeal squamous cell carcinoma classified as T3. Arch Otolaryngol Head Neck Surg. 2004;130(9):1092–9.
Pinar E, Imre A, Calli C, Oncel S, Katilmis H. Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes. Otolaryngol Head Neck Surg. 2012;147(6):1093–8.
Laccourreye O, Muscatello L, Laccourreye L, Naudo P, Brasnu D, Weinstein G. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for “early” glottic carcinoma classified as T1-T2N0 invading the anterior commissure. Am J Otolaryngol. 1997;18(6):385–90.
Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas. Laryngoscope. 2000;110(4):627–34.
Chevalier D, Laccourreye O, Brasnu D, Laccourreye H, Piquet JJ. Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients. Ann Otol Rhinol Laryngol. 1997;106(5):364–9.
Boscolo-Rizzo P, Maronato F, Marchiori C, Gava A, Da Mosto MC. Long-term quality of life after total laryngectomy and postoperative radiotherapy versus concurrent chemoradiotherapy for laryngeal preservation. Laryngoscope. 2008;118(2):300–6.
Bien S, Okla S, van As-Brooks CJ, Ackerstaff AH. The effect of a heat and moisture exchanger (Provox(A (R)) HME) on pulmonary protection after total laryngectomy: a randomized controlled study. Eur Arch Oto-Rhino-L. 2010;267(3):429–35.
Herranz J, Alvarez Espino M, Ogen Morado C. Pulmonary rehabilitation after total laryngectomy: a randomized cross-over clinical trial comparing two different heat and moisture exchangers (HMEs). Eur Arch Oto Rhino L. 2013; 270(9): 2479–84.
Wei W, Zhang N. Temporal correlation and multivariate analysis quality of life after laryngectomy. 2011 eleventh international and national head and neck academic conference. Hangzhou, Zhejiang Province, China: 2011:7.
Lefebvre JL, Ang KK. Larynx preservation clinical trial design: key issues and recommendations-A consensus panel summary. Int J Radiat Oncol Biol Phys. 2009;73(5):1293–303.
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Qian, W., Zhu, G., Wang, Y. et al. Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation. Med Oncol 31, 178 (2014). https://doi.org/10.1007/s12032-014-0178-2
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DOI: https://doi.org/10.1007/s12032-014-0178-2