Abstract
BackgroundFew reports from China provide confirmed evidence of the effectiveness of the larynx preservation strategy compared with surgery on the treatment of laryngeal and hypopharyngeal cancers. This study assessed the clinical outcomes of patients with locally advanced laryngeal and hypopharyngeal cancers treated with larynx preservation and determined the optimal larynx preservation procedure.MethodsData of 1,494 patients treated with total laryngectomy or larynx preservation between 2006 and 2014 were retrieved from the database of Sun-Yat Sen University Cancer Center in Guangzhou, China, and 366 eligible patients were selected for final analysis. The clinical outcomes of 228 patients received total laryngectomy and 138 patients received larynx preservation treatments, which comprises induction followed by radiotherapy and concurrent radio-chemotherapy, were compared.ResultsThere was no statistical difference in the 3-, 5-, and 10-year PFS and OS in patients received larynx preservation compared with patients treated with laryngectomy. With respect to T stage, a better overall OS in T2-stage disease (P = 0.036) but poorer PFS (P = 0.005) in T3-stage disease was observed in the larynx preservation group compared with the surgery group in Univariate analysis. T3-stage disease had poorer PFS in multivariable analysis (P = 0.022). With larynx preservation intent, induction chemotherapy followed by radiotherapy showed no advantage in the control of disease progression and survival compared with concurrent chemoradiotherapy. The patient subpopulations who received efficacy assessment after induction chemotherapy exhibited significantly longer PFS and OS compared with those without efficacy assessment.ConclusionsThis is the largest sample size study on larynx preservation treatment for laryngeal and hypopharyngeal cancers in China. Our results indicated that larynx preservation treatments did not jeopardize the survival of patients with advanced resectable laryngeal or hypopharyngeal cancers. Efficacy assessment should be emphasized in induction chemotherapy.
Highlights
Laryngeal and hypopharyngeal cancers are often analyzed in combination because of their adjacent anatomical location, similarity in treatment strategies, and effects on the patients’ quality of life
The records of 1,494 patients with laryngeal cancer and hypopharyngeal cancer were reviewed, and 366 patients with locally advanced laryngeal cancer or hypopharyngeal cancer who received their initial treatment in Sun Yat-Sen University Cancer Center (SYSUCC) were included in the analysis
There were 187 patients with laryngeal cancer and 179 patients with hypopharyngeal cancer, 51 (13.9%) cases was in T2-stage, 135 (36.9%) in T3-stage and 180 (49.2%) in T4-stage
Summary
Laryngeal and hypopharyngeal cancers are often analyzed in combination because of their adjacent anatomical location, similarity in treatment strategies, and effects on the patients’ quality of life. Laryngeal and hypopharyngeal cancers are traditionally treated with surgery, most often total laryngectomy, followed by post-operative radiotherapy [1] This strategy inevitably destroys the function of speech and swallowing, having a negative impact on patients’ quality of life. Several critical randomized clinical trials, including the VA study [2], EORTC 24891 trial [3, 4], and RTOG 91-11 trial [5, 6] proved the advantage of chemotherapy combined with radiotherapy in preserving larynx Encouraging results of these trials led to a change in the treatment guidelines for locally advanced laryngeal and hypopharyngeal cancers [7, 8]. This study assessed the clinical outcomes of patients with locally advanced laryngeal and hypopharyngeal cancers treated with larynx preservation and determined the optimal larynx preservation procedure
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