International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationOrgan Preservation With Concurrent Chemoradiation for Advanced Laryngeal Cancer: Are We Succeeding?
Introduction
Larynx cancer is the most common cancer subsite in head and neck oncology. For patients with advanced tumors (Stage III or IV) of the larynx and hypopharynx, treatment options are concomitant chemoradiation (CRT) with surgery as salvage, or up-front surgery followed by adjuvant radiotherapy, with or without concurrent chemotherapy. These multimodal regimens are equivalent in terms of survival, but CRT offers the potential advantage of organ preservation 1, 2, 3, 4, 5, 6, 7.
Unfortunately, organ preservation treatment protocols are associated with significant acute and late adverse effects. Therefore, quality of life and morbidity should be considered when a treatment is proposed. Quality of life relates to overall well-being including the functional, emotional, mental, social, and economic components. The most common predictors of quality of life in surviving patients with advanced laryngeal cancer receiving CRT appear to be absence of pain and lower incidence of mood disorder rather than preservation of speech function (8).
Intensity-modulated radiotherapy (IMRT) is starting to be used in the larynx and hypopharynx substites (9). Although experience with this modality is accumulating, we wanted to review our current results with conventional radiotherapy. Our goal was to determine rates of functional organ preservation and late toxicities in patients treated for advanced laryngeal and hypopharyngeal cancer at our tertiary care health center.
Section snippets
Patient and tumor characteristics
Between August 1998 and September 2005, a total of 105 patients with histologically proven laryngeal and hypopharyngeal squamous cell cancer (SCC) were treated with concurrent CRT at the Centre Hospitalier de l'Université de Montréal. Pretreatment evaluations consisted of a complete history and physical examination including direct laryngoscopy using a flexible fiberoptic endoscope. Dental evaluation was mandatory in all except edentulous patients. All patients had a complete blood count and
Treatment outcome
Overall survival, disease-free survival, and the laryngectomy-free survival were respectively 63%, 73%, and 53% at 3 years (Fig 1, Fig 2). Complete response rate with CRT was 75%. The primary tumor response rate was higher, with 88% complete response vs. 79% for nodal complete response.
Late toxicities
Nineteen patients (23%) experienced significant complications after CRT corresponding to Grade 2, 3, or 4 on the CTCAE scale. Six (7%) required a percutaneous gastrostomy (PEG), 5 (6%) had persistent Grade 2 or 3
Discussion
Few studies have addressed functional outcomes of larynx preservation protocols. The main goal of our study was to review the toxicity of laryngeal preservation treatments in our center for patient with advanced larynx or hypopharynx squamous cell carcinoma. Both subjective and objective swallowing problems are frequent and severe long-term side effects after radiotherapy for pharyngeal cancer. Swallowing dysfunction has been correlated with dose and volume parameters of the upper aerodigestive
Conclusion
In this study, half of all patients with advanced laryngeal or hypopharyngeal carcinomas treated with CRT, experienced either significant complications of laryngeal failure or locoregional relapse. For patients treated with the objective of preserving a functional larynx, PEG dependency and laryngectomy are frequent negative outcomes. More efforts and studies are necessary to further improve locoregional control, improve quality of life, and reduce late complications.
Given that survival appears
References (36)
- et al.
Multidisciplinary management of laryngeal carcinoma
Int J Radiat Oncol Biol Phys
(2007) - et al.
Meta-analyses of Chemotherapy in Head and Neck Cancer (MACH-NC): An update
Int J Radiat Oncol Biol Phys
(2007) - et al.
Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers
Int J Radiat Oncol Biol Phys
(2007) - et al.
A note on quantifying follow-up in studies of failure time
Controlled Clinical Trials
(1996) - et al.
A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003
Int J Radiat Oncol Biol Phys
(2000) - et al.
Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: Frequency, intensity and correlation with dose and volume parameters
Radiother Oncol
(2007) - et al.
Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship
Radiother Oncol
(2007) - et al.
Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: Early dose-effect relationships for the swallowing structures
Int J Radiat Oncol Biol Phys
(2007) - et al.
Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: Which anatomic structures are affected and can they be spared by IMRT?
Int J Radiat Oncol Biol Phys
(2004) - et al.
Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer
Int J Radiat Oncol Biol Phys
(2005)
Tolerance of normal tissue to therapeutic irradiation
Int J Radiat Oncol Biol Phys
Dosimetric predictors of laryngeal edema
Int J Radiat Oncol Biol Phys
[Organ preservation in ORL oncology: Myth or reality. The case for laryngeal preservation]
Cancer Radiother
Comparison of quality of life outcomes in laryngeal cancer patients following chemoradiation vs. total laryngectomy
Otolaryngol Head Neck Surg
Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy
Otolaryngol Head Neck Surg
An Intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer
J Clin Oncol
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
Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer
N Engl J Med
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Conflict of interest: none