Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies

Abstract

BackgroundThe utility of definitive radiotherapy (RT) for locoregionally advanced squamous cell carcinoma (SCC) of the larynx or hypopharynx in the setting of thyroid or cricoid cartilage invasion (TCCI) is controversial. A retrospective review of our experience was performed.MethodsOur institutional database of patients with SCC of the head and neck treated with radiotherapy (90% received concurrent systemic therapy) between 1995 and 2009 was queried. We identified 87 patients with T3-4 laryngeal or T4 hypopharyngeal cancer for whom initial head and neck imaging was available for review. Imaging of all patients was reviewed by a single radiologist specializing in neuroradiology. The presence and extent of TCCI was determined and used for stratification.ResultsMedian follow-up was 34 months. TCCI was found in 25 (29%) patients, eight limited to the inner cortex and another 17 involving both cortices. Local control (LC) was not significantly affected by TCCI limited to the inner cortex. However, TCCI involving both cortices was correlated with diminished LC at 2 years compared to the group of patients with no or minor invasion (55% vs. 81%, p=0.045). However, TCCI involving both cortices was not associated with significantly reduced rates of survival with a functional larynx, or overall survival (OS).ConclusionsOur results suggest that the rate of LC of T3-4 laryngeal or T4 hypopharyngeal SCC treated with definitive RT is not affected by TCCI of the inner cortex. Although decreased LC was significantly associated with TCCI involving both cortices, this factor did not appear to result in reduced rates of survival with a functional larynx or OS. Therefore, organ preservation may remain an option in these patients.

Management of locally advanced laryngeal cancer

“…More important is the motive to provide data supporting a common notion among head and neck surgeons that primary surgery remains a crucial part of T4 laryngeal cancer treatment. This comes in contradiction with another notion that has been recently introduced in the literature pointing that CCRT is a valid option for T4 laryngeal cancer and cartilage invasion should by no means considered a contraindication for enrolment in CCRT protocols [25,26]. If nothing else, it becomes clear that well-designed studies are necessary in order to provide solid evidence regarding the best treatment strategy for advanced laryngeal cancer.…”

Primary squamous cell carcinoma of the thyroid: Case report and systematic review of the literature

“…Some 17 publications with 48 cases without complete work-up, including CT-scan, panendoscopy, immunohistochemistry and double citations were excluded [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]. Finally, 35 papers and ours reporting on 50 patients were available for analysis [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58].

Fig. 2The flow chart of identified studies.

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T4a laryngeal cancer survival: Retrospective institutional analysis and systematic review

“…The PubMed and Embase search retrieved 807 articles. Twenty‐four articles were included (Fig. , Table ).…”