Postoperative irradiation in patients with pT3-4N0 laryngeal cancer: results and prognostic factors

Abstract

Approximately 60 % of patients with locally advanced laryngeal cancer (LALC) treated primarily with surgery require adjuvant radiotherapy. In the available literature predominate series of patients were with pathologically confirmed node-positive status. Subgroups of pN0 patients with LALC are scarce. The aim of the study is to evaluate the efficacy of postoperative radiotherapy in patients with pathological stage T3-4N0M0 and identification of prognostic factors in this group. Between 1975 and 2005, 138 patients with squamous pT3-4N0 laryngeal cancer were irradiated postoperatively. Primary surgical treatment consisted of total laryngectomy and cervical lymphadenectomy. The median time between surgery and the implementation of radiotherapy was 56 days. The median total dose was 60 Gy (range 40–70 Gy). Five-year disease-free survival (DFS5) was achieved in 76 % of patients. Cancer recurrence was observed in 34 patients. In 28 (82 %) cases it was locoregional failure. DFS5 rates for pT3 and pT4 were 92 and 69 %, for margin status R0, R1 and R2 were 82, 72 and 67 %, respectively. The pharyngeal invasion was related to a decrease in DFS5 from 80 to 59 %. Postoperative irradiation in patients with pT3-4N0 LALC is an effective treatment method. The main reason of the failure is local recurrence. The following independent prognostic factors were identified in this group of patients: pT stage, surgical margin status and pharyngeal invasion.

Does Thyroid Gland Preserving Total Laryngectomy Affect Oncological Control in Laryngeal Carcinoma?

“…Our 5‐year survival rates for thyroid sparing and lobectomy surgery were 40% and 25%, respectively. These are comparable to the literature that reports 5‐year disease‐free survival rates between 30% and 76% . Significantly more patients in the thyroid sacrificing group in our study had T4 disease ( P = .03), which might explain poorer outcomes in this group at 5 years, though disease‐free survival at 100 months was equal for the thyroid preserving and sacrificing groups.…”

Effect of Hospital to Home nutrition management model on postoperative clinical outcomes of patients with laryngeal carcinoma

“…Most of the traditional nutritional therapies focus on the nutritional status of patients only during hospitalization after surgery, and often neglect the nutritional status of the patients outside the hospital. After discharge of patients with laryngeal carcinoma, anorexia, nausea, vomiting and other symptoms often occur after postoperative radiotherapy and chemotherapy, and in particular, metabolic disorders caused by cachexia can appear in patients with advanced laryngeal carcinoma; therefore, it is necessary to improve the nutrition maintenance therapy of patients once outside the hospital ( 12 – 14 ). The H2H nutrition management model is a comprehensive treatment model with the patient at the center with continuous nutrition therapy for that patient from hospitalization to outside the hospital; the model uses a team approach involved by many medical disciplines (specialist physician, nutritionist, community physician, nurse and patient's family), which can improve patient compliance with nutritional therapy and minimize or ameliorate the status of malnutrition in patients.…”

Análisis de supervivencia de carcinoma escamoso de laringe en una cohorte retrospectiva chilena del Hospital Carlos Van Buren de Valparaíso

“…Se reportó una ausencia de tratamiento adyuvante en 30,6% de los pacientes sometidos a laringectomía total, lo que puede vincularse a la ausencia de un comité oncológico durante los primeros años estudiados en esta investigación. En esta línea, se ha descrito que aproximadamente un 60% de los pacientes en T3 y T4 que reciben tratamiento quirúrgico deberán ser sometidos a radiación adyuvante 26,27 , empero, esta cifra debe alcanzar el 100% en los pacientes portadores de un carcinoma T4. Al analizar los tiempos desde el diagnóstico hasta el inicio del tratamiento, se obtuvo una mediana de 4,14 semanas (RIC 2,71-8,14) cuando la cirugía fue el tratamiento primario y de 9,57 semanas (RIC 6,85-13) cuando fue radioterapia o radioquimioterapia.…”