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Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study was to analyze the results and survival of patients with T4a laryngeal squamous cell carcinoma (SCC) treated, according to clinical practice guidelines, with total laryngectomy and postoperative radiotherapy (TL–PORT) in a large and homogeneous series.

Methods

Initial staging assessment, treatment details, pathologic features, follow-up, and patterns of recurrence were retrospectively reviewed in a large series of 100 patients treated in our center between 2001 and 2013 for T4a laryngeal SCC with TL–PORT.

Results

Two-, 5-, and 10-year overall survival rates were 65, 52.4, and 33.3 %, respectively, while 2-, 5-, and 10-year disease-free survival rates were 55, 42.6, and 31.8 %, respectively. In addition, 2-, 5-, and 10-year locoregional control rates were 77, 74, and 65.9 %, respectively. Central lymph node involvement was associated with pathologic subglottic extension (p = 0.01), lysis of the cricoid cartilage (p = 0.03), and tracheal extension (p = 0.02). Extracapsular spread of central lymph node metastases, the main prognostic factor identified by multivariate analysis, was associated with decreased locoregional control and survival rates.

Conclusion

In this homogenously treated cohort, with consistent guideline application, surgery for T4a larynx cancer remains a standard of care, with current results used as a benchmark.

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References

  1. Forastiere AA, Weber RS, Trotti A. Organ preservation for advanced larynx cancer: issues and outcomes. J Clin Oncol. 2015;33:3262–8.

    Article  PubMed  Google Scholar 

  2. Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2013;11:917–23.

    Google Scholar 

  3. Wolf GT, Hong WK, Fisher SG, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. 1991;324:1685–90.

    Article  Google Scholar 

  4. Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.

    Article  CAS  PubMed  Google Scholar 

  5. Rosenthal DI, Mohamed AS, Weber RS, et al. Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: a 3-decade survey. Cancer. 2015;121:1608–19.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stenson KM, Maccracken E, Kunnavakkam R, et al. Chemoradiation for patients with large-volume laryngeal cancers. Head Neck. 2012;34:1162–7.

    Article  PubMed  Google Scholar 

  7. Mouw KW, Solanki AA, Stenson KM, et al. Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy. Oral Oncol. 2012;48:1025–30.

    Article  PubMed  Google Scholar 

  8. Bussu F, Micciche F, Rigante M, et al. Oncologic outcomes in advanced laryngeal squamous cell carcinomas treated with different modalities in a single institution: a retrospective analysis of 65 cases. Head Neck. 2012;34:573–9.

    Article  PubMed  Google Scholar 

  9. Worden FP, Moyer J, Lee JS, et al. Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion. Laryngoscope. 2009;119:1510–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Expert Panel on Radiation Oncology-Head and Neck, Salama JK, Saba N, et al. ACR appropriateness criteria® adjuvant therapy for resected squamous cell carcinoma of the head and neck. Oral Oncol. 2011;47:554–9.

    Article  Google Scholar 

  11. Gorphe P, Ben Lakhdar A, Tao Y, et al. Evidence-based management of the thyroid gland during a total laryngectomy. Laryngoscope. 2015;125:2317–22.

    Article  Google Scholar 

  12. Blanchard D, Barry B, De Raucourt D, et al. Guidelines update: post-treatment follow-up of adult head and neck squamous cell carcinoma: screening for metastasis and metachronous esophageal and bronchial locations. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:217–21.

    Article  CAS  PubMed  Google Scholar 

  13. Halimi C, Barry B, De Raucourt D, et al. Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Diagnosis of local recurrence and metachronous locations in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:287–90.

    Article  CAS  PubMed  Google Scholar 

  14. Chen AY, Fedewa S, Zhu J. Temporal trends in the treatment of early- and advanced-stage laryngeal cancer in the United States, 1985-2007. Arch Otolaryngol Head Neck Surg. 2011;137:1017–24.

    Article  PubMed  Google Scholar 

  15. Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope. 2006;116:1–13.

    Article  PubMed  Google Scholar 

  16. Grover S, Swisher-McClure S, Mitra N, et al. Total laryngectomy versus larynx preservation for T4a larynx cancer: patterns of care and survival outcomes. Int J Radiat Oncol Biol Phys. 2015;92:594–601.

    Article  PubMed  Google Scholar 

  17. Gourin CG, Conger BT, Sheils WC, et al. The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope. 2009;119:1312–7.

    Article  PubMed  Google Scholar 

  18. Patel UA, Howell LK. Local response to chemoradiation in T4 larynx cancer with cartilage invasion. Laryngoscope. 2011;121:106–10.

    Article  PubMed  Google Scholar 

  19. Dziegielewski PT, O’Connell DA, Klein M, et al. Primary total laryngectomy versus organ preservation for T3/T4a laryngeal cancer: a population-based analysis of survival. J Otolaryngol Head Neck Surg. 2012;41 Suppl 1:S56–64.

    PubMed  Google Scholar 

  20. American Society of Clinical Oncology, Pfister DG, Laurie SA, 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;24:3693–704.

    Article  Google Scholar 

  21. Lefebvre JL, Ang KK, Larynx Preservation Consensus Panel. Larynx preservation clinical trial design: key issues and recommendations: a consensus panel summary. Head Neck. 2009;31:429–41.

    Article  PubMed  Google Scholar 

  22. Francis E, Matar N, Khoueir N, et al. T4a laryngeal cancer survival: retrospective institutional analysis and systematic review. Laryngoscope. 2014;124:1618–23.

    Article  PubMed  Google Scholar 

  23. Knab BR, Salama JK, Solani A, et al. Functional organ preservation with definitive chemoradiotherapy for T4a laryngeal squamous cell carcinoma. Ann Oncol. 2008;19:1650–4.

    Article  CAS  PubMed  Google Scholar 

  24. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005;27:843–50.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank Lorna Saint Ange for editing.

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Authors and Affiliations

  1. Department of Head and Neck Oncology, Gustave Roussy Cancer Centre, Villejuif, France

    Philippe Gorphe MD, MSc, Margarida Matias MD, Antoine Moya-Plana MD, MSc, Florian Tabarino MD, François Janot MD & Stéphane Temam MD, PhD

  2. Department of Radiotherapy, Gustave Roussy Cancer Centre, Villejuif, France

    Pierre Blanchard MD, PhD & Yungan Tao MD, PhD

Authors
  1. Philippe Gorphe MD, MSc
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  2. Margarida Matias MD
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  3. Antoine Moya-Plana MD, MSc
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  4. Florian Tabarino MD
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  5. Pierre Blanchard MD, PhD
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  6. Yungan Tao MD, PhD
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  7. François Janot MD
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  8. Stéphane Temam MD, PhD
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Corresponding author

Correspondence to Philippe Gorphe MD, MSc.

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Gorphe, P., Matias, M., Moya-Plana, A. et al. Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy. Ann Surg Oncol 23, 2596–2601 (2016). https://doi.org/10.1245/s10434-016-5217-0

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  • DOI: https://doi.org/10.1245/s10434-016-5217-0

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