Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?
Öz
Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer (LC) with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy (CRT) is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy (RT)/CRT as the standard treatment regimen after surgery.
Methods: A retrospective review of T4 LC patients treated with CRT (17 patients) and adjuvant RT/CRT (26 patients) between 2015 and 2021 was conducted. Overall survival (OS), local regional recurrence-free survival (LRRFS), and disease-free survival (DFS) were compared between the groups. The organ preservation rate was determined for the CRT group.
Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9%, 51.4%, and 51.9%, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group (35.3% vs. 70.2%, p=0.007; 22.1% vs. 75.1%, p= 0.001; 22.1% vs. 75.7%, p=0.001). With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE (in the postoperative RT group, except LRRFS) were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patient’s request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5% in the CRT group.
Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patient’s request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.
Anahtar Kelimeler
Laryngeal cancer advanced stage organ preservation radiotherapy laryngectomy treatment outcome
Kaynakça
- Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2016;66:7-30. doi: 10.3322/caac.21332
- American Society of Clinical Oncology; 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;24:3693-3704. doi: 10.1200/JCO.2006.07.4559
- Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685-1690. doi: 10.1056/NEJM19910613324240
- Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091-2098. doi: 10.1056/NEJMoa031317
- Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998;124:964-971.
- Richard JM, Sancho-Garnier H, Pessey JJ, et al. Randomized trial of induction chemotherapy in larynx carcinoma. Oral Oncol. 1998;34:224-228. doi: 10.1016/s1368-8375(97)00090-0
- World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79:373-374.
- 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;31:845-852. doi: 10.1200/JCO.2012.43.6097
- Patel SA, Qureshi MM, Dyer MA, Jalisi S, Grillone G, Truong MT. Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer. Cancer. 2019;125:3367-3377. doi: 10.1002/cncr.32292
- Stokes WA, Jones BL, Bhatia S, et al. A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ-preservation approaches: A National Cancer Data Base analysis. Cancer. 2017;123:600-608. doi: 10.1002/cncr.30382
- Brandstorp-Boesen J, Falk RS, Boysen M, Brøndbo K. Long-term trends in gender, T-stage, subsite and treatment for laryngeal cancer at a single center. Eur Arch Otorhinolaryngol. 2014;271:3233-3239. doi: 10.1007/s00405-014-3100-9
- Fong PY, Tan SH, Lim DWT, et al. Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC). PLoS One. 2019;14:e0224665. doi:10.1371/journal.pone.0224665
- Patel SG, Lydiatt WM, Glastonbury CM, et al. Larynx. Amin MB, ed, American Joint Committee on Cancer staging manual, 8th edn. NewYork: Springer; 2017.
- Lewis CM, Chinn SB, Holsinger C, Weber RS. Cancer of the Larynx: Tis, T1, T2 Evaluation and Management. Bernier J, eds, Head and neck cancer multimodality management, 2nd edn. Switzerland: Springer; 2016.
- Sharrett JM, Ward MC, Murray E, et al. Tumor volume useful beyond classic criteria in selecting larynx cancers for preservation therapy. Laryngoscope. 2020;130:2372-2377. doi:10.1002/lary.28396
- Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945-1952. doi:10.1056/NEJMoa032641
T4 larinks kanseri için tedavi seçimi: kemoradyoterapi ile organ koruyucu yaklaşım mümkün mü yoksa multimodalite tedavi daha mı etkili?
Öz
Amaç: Organ koruyucu yaklaşım, ileri evrede larinks kanseri (LK) için benzer sağkalım sonuçları ile kanıta dayalı bir tedavi seçeneği olarak önerilmektedir. Ancak T4 hastalıkta organ koruma yaklaşımı tartışmalıdır ve öncelikle cerrahi tedavi tercih edilmektedir. Bu çalışmanın amacı, kemoradyoterapi (KRT) ve postoperatif radyoterapi (RT)/KRT uygulanan T4 LK'li hastalarda tedavi sonuçlarını değerlendirmektir.
Gereç ve Yöntem: 2015 ve 2021 yılları arasında KRT (19 hasta) ve adjuvan RT/KRT (27 hasta) ile tedavi edilen T4 LK hastalarının retrospektif incelemesi yapılmıştır. Gruplar arasında genel sağkalım (GS), lokal bölgesel rekürrenssiz sağkalım (LBRS) ve hastalıksız sağkalım (HS) karşılaştırıldı. KRT grubu için organ koruma oranı belirlendi.
Bulgular: Tüm kohort için medyan takip süresi 39,5 aydı; 5 yıllık GS, LBRS, HS sırasıyla %52,5, %48,1 ve %48,1 idi. 5 yıllık GS, LBRS ve HS oranları açısından tedavi grupları arasında istatistiksel olarak anlamlı fark bulundu ve KRT grubunda sağkalımın azaldığı saptandı (%31,6 vs %67,6, p=0,004; %19,7 vs %72,3, p=0,001; %19,7 vs %72,9, p=0,001). Diğer klinikopatolojik faktörler açısından; çok değişkenli analizde yaş sadece GS üzerinde anlamlıydı, tümör boyutu, nodal evre ve ECE (ameliyat edilen hastalarda) GS, LBRS ve HS oranları ile bağlantılıydı. KRT grubunda 3 yıllık organ koruma oranı %81,5 idi.
Sonuç: Cerrahi kolu, KRT grubuna kıyasla GS, LBRS, HS açısından istatistiksel olarak anlamlı derecede üstün sonuçlara sahipti. Bununla birlikte, KRT kolunda büyük ölçüde laringeal koruma gözlendi.
Anahtar Kelimeler
Larinks kanseri İleri evre Organ koruma Radyoterapi Larenjektomi Sonuç
Kaynakça
- Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2016;66:7-30. doi: 10.3322/caac.21332
- American Society of Clinical Oncology; 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;24:3693-3704. doi: 10.1200/JCO.2006.07.4559
- Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685-1690. doi: 10.1056/NEJM19910613324240
- Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091-2098. doi: 10.1056/NEJMoa031317
- Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998;124:964-971.
- Richard JM, Sancho-Garnier H, Pessey JJ, et al. Randomized trial of induction chemotherapy in larynx carcinoma. Oral Oncol. 1998;34:224-228. doi: 10.1016/s1368-8375(97)00090-0
- World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79:373-374.
- 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;31:845-852. doi: 10.1200/JCO.2012.43.6097
- Patel SA, Qureshi MM, Dyer MA, Jalisi S, Grillone G, Truong MT. Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer. Cancer. 2019;125:3367-3377. doi: 10.1002/cncr.32292
- Stokes WA, Jones BL, Bhatia S, et al. A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ-preservation approaches: A National Cancer Data Base analysis. Cancer. 2017;123:600-608. doi: 10.1002/cncr.30382
- Brandstorp-Boesen J, Falk RS, Boysen M, Brøndbo K. Long-term trends in gender, T-stage, subsite and treatment for laryngeal cancer at a single center. Eur Arch Otorhinolaryngol. 2014;271:3233-3239. doi: 10.1007/s00405-014-3100-9
- Fong PY, Tan SH, Lim DWT, et al. Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC). PLoS One. 2019;14:e0224665. doi:10.1371/journal.pone.0224665
- Patel SG, Lydiatt WM, Glastonbury CM, et al. Larynx. Amin MB, ed, American Joint Committee on Cancer staging manual, 8th edn. NewYork: Springer; 2017.
- Lewis CM, Chinn SB, Holsinger C, Weber RS. Cancer of the Larynx: Tis, T1, T2 Evaluation and Management. Bernier J, eds, Head and neck cancer multimodality management, 2nd edn. Switzerland: Springer; 2016.
- Sharrett JM, Ward MC, Murray E, et al. Tumor volume useful beyond classic criteria in selecting larynx cancers for preservation therapy. Laryngoscope. 2020;130:2372-2377. doi:10.1002/lary.28396
- Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945-1952. doi:10.1056/NEJMoa032641
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Radyoterapi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Ağustos 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 4 |
Kaynak Göster
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