The Laryngoscope · 2011
Local response to chemoradiation in T4 larynx cancer with cartilage invasion.
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Patel Urjeet A, Howell Lori K
Аннотация
BACKGROUND: Patients with cartilage invasion were excluded from organ preservation protocols treating laryngeal and hypopharyngeal cancer. Treatment choice between chemoradiotherapy (CRT) and total laryngectomy (TL) remains controversial for these patients.
OBJECTIVE: To assess local response and local recurrence after CRT for patients having T4 larynx or hypopharynx cancer with cartilage invasion.
DESIGN: Retrospective intervention study.
SETTING: : Tertiary-care, urban public hospital.
PATIENTS: Patients with T4 squamous cell carcinoma of the larynx/hypopharynx with cartilage invasion treated from 2003 to 2009.
INTERVENTION: Curative-intent CRT, compared to TL.
OUTCOME MEASURES: Local response and local recurrence.
RESULTS: Of 34 patients included in this study, 21 completed CRT and 13 underwent TL with postoperative RT or CRT. With CRT, 19 patients were noted to have a complete response at the primary site while two patients had persistent local disease. Of 19 patients with complete response, 4 developed local recurrence over a time period 76-226 days (mean: 177 days). This resulted in a 29% incidence of persistent/recurrent disease at the primary site. The remaining 15 patients (71%) remained free of local disease (mean follow-up: 369 days). For 13 patients undergoing TL with adjuvant therapy, there were no cases of local recurrence (mean follow-up: 389 days).
CONCLUSIONS: Although there was a high initial complete response rate after CRT, this response was not durable with a high local recurrence rate within 1 year. In comparison, patients undergoing TL demonstrated markedly better local control. For patients with cartilage invasion, a prospective trial comparing medical versus surgical therapy is needed.
OBJECTIVE: To assess local response and local recurrence after CRT for patients having T4 larynx or hypopharynx cancer with cartilage invasion.
DESIGN: Retrospective intervention study.
SETTING: : Tertiary-care, urban public hospital.
PATIENTS: Patients with T4 squamous cell carcinoma of the larynx/hypopharynx with cartilage invasion treated from 2003 to 2009.
INTERVENTION: Curative-intent CRT, compared to TL.
OUTCOME MEASURES: Local response and local recurrence.
RESULTS: Of 34 patients included in this study, 21 completed CRT and 13 underwent TL with postoperative RT or CRT. With CRT, 19 patients were noted to have a complete response at the primary site while two patients had persistent local disease. Of 19 patients with complete response, 4 developed local recurrence over a time period 76-226 days (mean: 177 days). This resulted in a 29% incidence of persistent/recurrent disease at the primary site. The remaining 15 patients (71%) remained free of local disease (mean follow-up: 369 days). For 13 patients undergoing TL with adjuvant therapy, there were no cases of local recurrence (mean follow-up: 389 days).
CONCLUSIONS: Although there was a high initial complete response rate after CRT, this response was not durable with a high local recurrence rate within 1 year. In comparison, patients undergoing TL demonstrated markedly better local control. For patients with cartilage invasion, a prospective trial comparing medical versus surgical therapy is needed.