Larynx preservation: What is the best non-surgical strategy?

Lagha, Aymen; Chraiet, Nesrine; Labidi, Soumaya; Rifi, Hela; Ayadi, Mouna; Krimi, Sarra; Allani, Bassem; Raies, Henda; Touati, S.; Boussen, Hamouda; Kochbati, L.; Mézlini, Amel

doi:10.1016/j.critrevonc.2013.05.005

Cited by 13 publications

(18 citation statements)

References 56 publications

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“…Organ preserving surgery and combinations of chemotherapy with radiation as alternatives to total laryngectomy have been popularized to promote preservation of laryngeal function in patients with advanced disease. Results of randomized clinical trials of surgical versus non-surgical approaches however, have failed to show significant improvements in disease specific or overall survival or clear superiority of one approach over another 14,24,30,31 . Despite this, concurrent chemoradiation approaches have been widely adopted based on the desire for larynx preservation and evidence from meta-analyses that concurrent chemoradiation is superior to radiation alone and may also be superior to neoadjuvant or sequential chemotherapy combined with radiation 20–22 .…”

Section: Discussionmentioning

confidence: 99%

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Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

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The introduction of chemoradiation for advanced laryngeal cancer led to a major paradigm shift in treatment as an alternative to laryngectomy. Despite widespread adoption, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed. A unique approach incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiation was studied to determine if improved survival could be achieved. Design From 2002–2012, we treated an unselected cohort of 247 patients with laryngeal cancer in an academic institution. Interventions Limited disease patients (n=94) underwent endoscopic resection (n=33; 35%), radiation (n=50; 53%) or chemoradiation for deeply invasive T2 lesions (n=11; 12%). For advanced disease (n=153), neoadjuvant chemotherapy for treatment selection (n=71; 46%), concurrent chemoradiation (n=50; 33%) or primary surgery (n=32; 21%) was recommended. Outcomes Propensity for treatment selection in advanced patients was modeled using logistic regression. Overall (OS) and disease specific survival (DSS) were analyzed with Cox proportional hazards models stratified by propensity score. Median follow was 48 months. Results Five-year OS and DSS was 75% (95% C.I. 68–81%) and 83% (77–88%), respectively for the entire cohort. DSS was 92% (83–97%) for patients with Stage I, II and 78% (69–84%) for patients with Stage III, IV disease. For advanced disease patients, 5-year OS (and DSS) ranged from 78% (91%) for surgery to 76% (79%) for neoadjuvant bioselection and 61% (66%) for primary chemoradiation. Propensity-adjusted multivariable Cox models controlling for known prognostic factors showed DSS was significantly improved in the neoadjuvant group compared to definitive chemoradiation [Hazard ratio 0.48, 95%CI: (0.29, 0.80), p=0.005]. DSS for the definitive surgery group was significantly better compared to the neoadjuvant bioselection group, [Hazard ratio 0.34, 95%CI: (0.14, 0.82), p=0.02]. Larynx preservation was achieved in 65% of advanced patients. Conclusions Exceptional survival rates were achieved with a bioselective treatment approach utilizing a single cycle of neoadjuvant chemotherapy. Excellent survival rates were also achieved in patients selected for primary surgery and both were better than with concurrent chemoradiation suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.

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Section: Discussionmentioning

confidence: 99%

“…The debate between primary total laryngectomy versus concurrent or neoadjuvant chemoradiation has not been resolved 10,30,31 . Most studies document higher survival rates with primary surgery but at the sacrifice of laryngeal function.…”

Section: Discussionmentioning

confidence: 99%

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

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“…Moreover, extrapolation data for laryngeal tumors from studies focused on the treatment of hypopharyngeal cancers may not be appropriate because the latter have a worse overall prognosis due to the high rate of distant metastasis and poor results of salvage surgery [2]. All these differences lead to several challenges in providing shared guidelines for a standard of care in clinical practice [2,20].…”

Section: Combined Ct-rt Approachesmentioning

confidence: 98%

“…At present, the treatment options for non-surgical larynx preservation strategies in patients with advanced stage (III and IV) laryngeal-hypopharyngeal cancer are: cRT-CT (using CDDP 100 mg/m 2 every 3 weeks) (preferred in North America), iCT (TPF) followed by RT in good responders (preferred in Europe), alternating CT-RT and RT alone [1,2,20]. None of these approaches has demonstrated an advantage in terms of survival compared to upfront surgery.…”

Section: Combined Ct-rt Approachesmentioning

confidence: 99%

“…Until results of the RTOG 91-11 trial were published, cCT-RT (CDDP 100 mg/m 2 on days 1,22,43 concomitant to RT up to a total dose of 70 Gy 2 Gy/die) has been considered the standard treatment in locally advanced laryngeal cancer treated within an OP strategy (level I evidence) [1,2,17,20]. RTOG 91-11 excluded hypopharynx tumors and laryngeal tumor staged as T1 or T4 with cartilage penetration or with extension of more than 1 cm in the base of tongue [5].…”

Section: Indication For Cct-rtmentioning

confidence: 99%

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Non-surgical organ preservation strategies for locally advanced laryngeal tumors: what is the Italian attitude? Results of a national survey on behalf of AIRO and AIOM

Alterio

Franco

Numico³

et al. 2016

Med Oncol

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Chemoradiotherapy is the treatment mostly used as organ preservation (OP) strategy worldwide in advanced laryngo-hypopharyngeal cancer. Due to the not homogeneous results of the literature data regarding the pre-treatment assessment and treatment schedule in this setting of patients, the Italian societies of radiation oncology and medical oncology surveyed (by an online survey) their memberships regarding the Italian attitude on larynx preservation in clinical practice. The survey outline addressed different items such as: demographics (11 items), pre-treatment evaluation (12 items), treatment schedules (10 items) and outcomes (3 items). The survey was filled in by 116 clinical oncologists (64 % radiation and 36 % medical oncologists). Results highlighted that pretreatment evaluation was not homogeneous among the respondents. The treatment of choice for the OP program resulted the concurrent chemoradiotherapy (66 %). Induction chemotherapy was proposed mostly in case of aggressive tumors such as advanced stage (T4 or N3) and/or unfavorable primary sites (hypopharynx). Moreover, after induction chemotherapy, for responders patients most participants (46 %) proposed concurrent chemoradiotherapy, while 18 and 19 % proposed radiotherapy alone or radiotherapy and cetuximab, respectively. For patients with stable disease after induction chemotherapy, the respondents declared to suggest surgery, radiotherapy and cetuximab or radiotherapy alone in 38, 32 and 15 % of cases, respectively. Results of the present survey highlighted the variability of therapeutic approaches offered in clinical practice for patients candidate to a larynx OP program. Analysis of abovementioned results may give the chance to modify some clinical attitudes and create the background for future clinical investigation in this field.

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Induction chemotherapy‐based organ‐preservation protocol improve the function preservation compared with immediate total laryngectomy for locally advanced hypopharyngeal cancer—Results of a matched‐pair analysis

et al. 2023

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BackgroundWe performed a paired analysis to compare the therapeutic effect between the induction chemotherapy‐based organ‐preservation approach and immediate total laryngectomy in hypopharyngeal squamous cell carcinoma patients requiring total laryngectomy.Methods351 patients who were treated with organ‐preservation approach were compared with 110 patients who were treated with total laryngectomy. The main measures and outcomes were progression‐free survival (PFS), overall survival (OS), and larynx function preservation survival (LFPS).ResultsNo statistical difference was observed for 3‐, 5‐, and 10‐year PFS and OS in two groups. In the organ‐preservation group, the 3‐, 5‐, and 10‐year LFPS was 30.7%, 23.3%, and 16.6%, respectively. The LFPS of Stage III > Stage IV, N0 > N1 > N2 > N3, T2 > T3 > T4, CR > PR > SD > PD patients (all p values <0.05).ConclusionsSurvival outcomes did not significantly differ between the two groups. The organ‐preservation approach allowed more than 70% of the survivors to retain their larynx function.

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Larynx preservation: What is the best non-surgical strategy?

Cited by 13 publications

References 56 publications

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Non-surgical organ preservation strategies for locally advanced laryngeal tumors: what is the Italian attitude? Results of a national survey on behalf of AIRO and AIOM

Induction chemotherapy‐based organ‐preservation protocol improve the function preservation compared with immediate total laryngectomy for locally advanced hypopharyngeal cancer—Results of a matched‐pair analysis

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