Survival Outcomes in Advanced Laryngeal Cancer

Megwalu, Uchechukwu C.; Sikora, Andrew G.

doi:10.1001/jamaoto.2014.1671

Cited by 208 publications

(269 citation statements)

References 8 publications

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“…The outcomes of treatment of the subset of patients with T3 laryngeal cancer with N0 disease reported by Megwalu and Sikora, 7 showed inferior 5-year OS (48% vs 59%) and DSS (63% vs 69%) for larynx preservation compared to the surgical cohort. However, the discrimination between IMRT and conventional RT is not possible, and dichotomizing RT alone and CRT for larynx preservation cannot be performed in this Surveillance, Epidemiology, and End Results database.…”

Section: Discussionmentioning

confidence: 93%

“…[3][4][5][6][7] For example, Hoffman et al, 3 using a robust NCDB, reported that increased use of nonsurgical approaches for larynx preservation was concurrent with decreased relative survival in patients with T3 laryngeal cancers. However, because Hoffman et al 3 culled data from between 1985 and 2001, before the implementation of IMRT and the publication of RTOG 9001 and the more widespread use of induction and concurrent chemotherapy, their findings, although timely when published, do not accurately reflect the use of RT and combined modality techniques in the current era.…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies' findings have implied that nonsurgical larynx preservation approaches may be associated with survival decrement. [3][4][5][6][7] Specifically, Hoffman et al, 3 using large-scale series from the National Cancer Data Base (NCDB), reported that the increased use of organ preservation approaches was associated with a decrement in relative survival in patients with T3 laryngeal cancer. Gourin et al, 4 in a retrospective series of locally advanced disease, demonstrated that nonsurgical larynx preservation was associated with poorer survival particularly for patients with T4 disease.…”

Section: Introductionmentioning

confidence: 99%

“…Another NCDB analysis reported by Chen et al, 6 showed increased mortality risk among patients with T3 disease treated with nonsurgical approaches, particularly in patients treated by radiotherapy (RT) alone. More recently, Megwalu and Sikora, 7 analyzing grouped survival data from the Surveillance, Epidemiology, and End Results 18 registry, reported that patients with some T3 laryngeal cancers who were treated with surgery had better survival outcomes than those who were treated with nonsurgical management. These findings have led some researchers to question the utility of chemoradiation as first-line therapy for T3 laryngeal cancer.…”

Section: Introductionmentioning

confidence: 99%

“…These findings have led some researchers to question the utility of chemoradiation as first-line therapy for T3 laryngeal cancer. [3][4][5][6][7] This is not an invalid concern, as the VA and RTOG trials took place in an era before the introduction of modern RT techniques. The VA 1 and RTOG 2 studies, designed and conducted several decades ago, enrolled patients who were treated with nonvolumetric imaging-based conventional 2D or 3D CRT (2D/3D CRT).…”

Section: Introductionmentioning

confidence: 99%

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Erratum

2017

Head & Neck

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Long-term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches. Head Neck 2016; 38(12):1739-1751. DOI 10.1002/ hed.24532.The authors have brought to our attention that during production the acronym "LP-PORT" was incorrectly inserted in place of the correct acronym "TL-PORT" (total laryngectomy with post-operative radiotherapy) in the Results and the Discussion sections. The publisher regrets this error. The entire revised article follows. ABSTRACT: Background. The purpose of this study was to evaluate the long-term outcomes after initial definitive or adjuvant radiotherapy (RT) for T3 laryngeal cancers. Methods. We reviewed 412 patients treated for T3 laryngeal squamous cell cancer from 1985 to 2011. Results. The 10-year overall survival (OS) was 35%; disease-specificsurvival (DSS) was 61%; locoregional control was 76%; and freedom from distant metastasis was 83%. Chemotherapy, age, performance status <2, node-negative status, and glottic subsite were associated with improved survival (all p < .03). Larynx preservation with induction and/ or concurrent chemoradiotherapy (LP-CRT) had better laryngectomy-free survival than RT alone (LP-RT; hazard ratio [HR] 5 0.62; 95% confidence interval [CI] 5 0.47-0.81; p 5 .0005); 10-year laryngectomyfree survival rates of the LP-CRT cohort (37%) were higher than those of the LP-RT cohort (18%). The 5-year DSS and OS rates of the LP-CRT cohort (79% and 67%) were better after total laryngectomy with postoperative RT (TL-PORT; 61% and 50%) and LP-RT (64% and 46%; p < .006 for all). Conclusion. In patients with T3 laryngeal cancers, LP-CRT provides better functional, oncologic, and survival outcomes than historical TL-PORT or LP-RT does.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Erratum

2017

Head & Neck

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Oncologic and Functional Outcomes of Surgical and Nonsurgical Treatment of Advanced Squamous Cell Carcinoma of the Supraglottic Larynx

Elegbede

Rybicki

Adelstein

et al. 2015

JAMA Otolaryngol Head Neck Surg

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Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx

Bonner

Giralt

Harari

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE The appropriate use of surgery or radiotherapy-based approaches for organ preservation has been the subject of much debate. Unfortunately, there has been a lack of improvement in overall survival for patients with laryngeal carcinoma in the last 30 years. OBJECTIVE To assess the rates of laryngeal preservation and laryngectomy-free survival in patients receiving cetuximab and radiotherapy (CRT) and patients receiving radiotherapy alone. DESIGN, SETTING, AND PARTICIPANTS Patients were enrolled in a multicenter, open-label, stratified, randomized, phase 3 study from April 1, 1999, through March 31, 2002, from 73 centers in the United States and 14 other countries. A secondary subgroup analysis of patients with hypopharyngeal and laryngeal carcinoma was undertaken. Rates of laryngeal preservation and laryngectomy-free survival were estimated by the Kaplan-Meier method. The hazard ratios (HRs) were calculated using a Cox proportional hazards regression model. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer core questionnaire and head and neck module. MAIN OUTCOMES AND MEASURES Laryngeal preservation and laryngectomy-free survival. RESULTS Of the 424 patients included in the trial, 168 treated patients with cancer of the larynx or hypopharynx were included in this analysis (90 in the CRT group and 78 in the radiotherapy alone group). The median (range) age of the patients was 59 (40-80) years in the CRT group and 61 (35-81) years in the radiotherapy alone group. In the CRT group, 72 patients (80.0%) were male and 18 (20.0%) were female. In the radiotherapy alone group, 62 (79.5%) were male and 16 (20.5%) were female. The rates of laryngeal preservation at 2 years were 87.9% for CRT vs 85.7% for radiotherapy alone, with an HR of 0.57 (95% CI, 0.23-1.42; P = .22). Similarly, the HR for laryngectomy-free survival comparing CRT vs radiotherapy alone was 0.78 (95% CI, 0.54-1.11; P = .17). This study was not powered to assess organ preservation. Median overall survival was 27 (95% CI, 20-45) vs 21 (95% CI, 17-35) months for the CRT and radiotherapy alone groups, respectively, with an HR of 0.87 (95% CI, 0.60-1.27). No differences between treatments were reported regarding overall quality of life, need for a feeding tube, or speech. CONCLUSIONS AND RELEVANCE The results of a possible cetuximab-related laryngeal preservation benefit for patients with hypopharyngeal or laryngeal cancer are intriguing; these results need to be interpreted in the context of a retrospective subset analysis with limited sample size. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00004227

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Survival Outcomes in Advanced Laryngeal Cancer

Cited by 208 publications

References 8 publications

Erratum

Erratum

Oncologic and Functional Outcomes of Surgical and Nonsurgical Treatment of Advanced Squamous Cell Carcinoma of the Supraglottic Larynx

Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx

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