Radical surgery and postoperative radiotherapy in patients with advanced squamous cell carcinoma of the larynx

Valentina Krstevska,Emilija Lazarevska,Igor Stojkovski,Simonida Crvenkova

doi:10.2298/aoo1102017k

Valentina Krstevska, Emilija Lazarevska + Show 2 more

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https://doi.org/10.2298/aoo1102017k

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Abstract

Background: The aim of this study is to analyze the results of radical surgery followed by postoperative radiotherapy in patients with advanced laryngeal cancer. Methods: Seventy-seven patients with advanced laryngeal cancer were treated with postoperative radiotherapy following total laryngectomy with or without neck dissection. Median age of patients at the diagnosis was 57 years (range, 43-76). The median follow-up was 41 months (range, 11-70). Radiotherapy was performed using three-dimensional conformal technique. Results: Median duration of overall radiation treatment time was 5.9 weeks (range, 5.4-7.6). Median total dose delivered was 60 Gy (range, 50-66). Locoregional relapse was the most frequent pattern of failure. A 5-year locoregional control (LRC) and overall survival (OS) rates were 72.3% and 66.2%, respectively. A 5-year LRC and OS rates were significantly higher in patients without nodal disease (N0) as compared to patients with metastatic involvement of the neck lymph nodes (N+) (p=0.009 and p=0.002, respectively). Confluent mucositis was developed in 16 patients (20.8%). Late toxicity most frequently occurred in the skin as well as in the mucous membrane and in the subcutaneous tissue and was grade 1 reaction (74.0%, 67.5%, and 72.7%, respectively). Conclusion: In order to improve treatment results in terms of LRC and OS and following evidence-based treatment recommendations for patients with advanced laryngeal cancer whose initial treatment was radical surgery, we strongly advocate the acceptance of postoperative concurrent chemoradiotherapy in cases with surgical specimen demonstrating high-risk pathological features.

Highlights

From the second half of the 20th century, the randomized independent clinical trials designed by European Organization Oncology modern “wide field” total laryngectomy combined with a neck dissection for Research and Treatment of Cancer (EORTC) and Radiation Oncology was considered a treatment of choice for advanced laryngeal cancer [1]
The treatment of advanced laryngeal cancer cally involved surgical margins, extracapsular extension in positive lymph seams to be a permanent challenge, but the management of patients node, two or more positive lymph nodes, vascular embolism and perineuwith advanced laryngeal cancer has become more complex as other ral infiltration, postoperative concurrent chemoradiotherapy was revealed modalities including induction chemotherapy followed by radiotherapy or to be more efficacious compared to postoperative radiotherapy in terms concurrent chemoradiotherapy have evolved with the goal of preserving of locoregional control (LRC) and survival [5]
Reviewing the data from the literature addressing the results of postoperative radiotherapy following radical surgery in patients with advanced laryngeal cancer, we found that a 5-year LRC of 72.3% achieved in our study corresponds with a 5-year LRC rate of 74% in the retrospective study performed by Nguyen-Tan et al [6] on 146 patients treated with total laryngectomy and adjuvant radiotherapy