Efficacy of laryngectomy alone for treatment of locally advanced laryngeal cancer: A stage‐ and subsite‐specific survival analysis

Cervenka, Brian; Rao, Shyam; Farwell, D. Gregory; Bewley, Arnaud F.

doi:10.1111/coa.13018

Cited by 6 publications

(7 citation statements)

References 30 publications

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“… 15 , 16 In addition, some epidemiological studies reported a decline in survival for patients with LSCC, possibly attributable to the increased use of RT and CRT protocols. 17 , 18 RT is considered an important adjunct for most of head and neck tumors, since it can address the residual microscopic tumor burden after the excision, but there are several factors related to the laryngeal anatomic disease that may reduce the likelihood of locoregional residual disease, 19 in particular, fascial barriers surrounding larynx that provide natural fence to tumor spread, the relatively poor lymphatic network from the glottis, and the wide margins achievable with interventions like total laryngectomy. 19 Differently from other head and neck tumor subsites, postoperative RT is not recommended for patients with T3 N0‐1 glottic cancer treated with total laryngectomy or T3 N0 glottic cancer treated with partial laryngectomy, in the absence of other high‐risk features (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…6 Despite these recommendation for selective use of postoperative RT in patients with locally advanced LSCC, many patients who underwent surgery are still treated with adjuvant RT. 19 Several authors have already questioned the role of postoperative RT for patient with T3 N0‐1 LSCC treated with primary surgery, 5 , 20 , 21 mainly because RT may deeply affect functional outcomes after laryngeal surgery, eventually decreased quality of life. 7 Moreover, the change in the laryngeal appearance might undermine follow‐up clinical examination and endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…However, T3 N0 supraglottic cancers treated with partial or total laryngectomy, postoperative RT (or CRT) should be discussed, especially if high‐risk features are present 6 . Despite these recommendation for selective use of postoperative RT in patients with locally advanced LSCC, many patients who underwent surgery are still treated with adjuvant RT 19 . Several authors have already questioned the role of postoperative RT for patient with T3 N0‐1 LSCC treated with primary surgery, 5,20,21 mainly because RT may deeply affect functional outcomes after laryngeal surgery, eventually decreased quality of life 7 .…”

Section: Discussionmentioning

confidence: 99%

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pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients

et al. 2021

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Objectives/Hypothesis: To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC).Study Design: Multicentric retrospective cohort study. Methods: Multicentric retrospective case series of previously untreated patients with pT3 R0N0 LSCC, who received exclusive surgery between 2011 and 2019. Tumor location; subsite involvement; grading; and lymphatic, vascular, and perineural invasion were reported. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were measured.Results: Fifty-four patients (mean age 67.1; male sex 83.3%; mean follow-up period 37 months) underwent total laryngectomy (48.1%) or partial laryngectomy (51.9%). Ipsilateral or bilateral neck dissection was performed in 46 (85.2%) cases. Perineural invasion was more frequent in case of supraglottic involvement than glottic involvement (85.7% vs. 14.3%, P = .03). Five (9.3%) patients experienced recurrence (3 local recurrences, 1 nodal recurrence, 1 distant recurrence). Rate of recurrence differed between glottic (0%), supraglottic (80%), and transglottic (20%) tumors (P = .01), with a lower risk yielded by glottic involvement (odds ratio [OR], 0.05, 95% confidence interval [95% CI], 0.01-0.56, P = .01). A higher risk was recorded in case of perineural invasion (OR, 66.0, 95% CI, 1.41-3085.3, P = .03). The OS, DSS, and DFS were 79.6%, 96.3%, and 90.7%, without differences regarding the type of surgery. The DFS was lower in case of supraglottic involvement when compared to purely glottic LSCC (83.9% vs. 100%, P = 0.02).Conclusions: Exclusive surgery is a safe option for patients with pT3 R0N0 LSCC. Adjuvant treatments or closer followup monitoring might be considered in case of supraglottic involvement or perineural invasion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients

et al. 2021

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“…[7][8][9] Compared with non-Medicaid insured groups, Medicaid insured cancer patients have been shown to have higher disease-specific mortality before diagnosis and higher mortality than the non-Medicaid groups after diagnosis. 10 Previous literature describes insurance status and type to be independent predictors of poor survival in laryngeal cancers, 11 and recent studies show disparities in nasopharyngeal carcinoma (NPC) survival among racial and ethnic minority groups in the United States. 12 To our knowledge, no study to date has specifically analyzed NPC survival outcomes with respect to insurance status.…”

Section: Introductionmentioning

confidence: 99%

Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis

Diaz

Bujnowski

Chen

et al. 2022

J Neurol Surg B Skull Base

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Objectives Insurance coverage plays a critical role in head and neck cancer care. This retrospective study examines how insurance coverage affects nasopharyngeal carcinoma (NPC) survival in the United States using the Surveillance, Epidemiology, and End Results (SEER) program database. Design, Setting, and Participants A total of 2,278 patients aged 20 to 64 years according to the International Classification of Diseases for Oncology (ICD-O) codes C11.0–C11.9 and ICD-O histology codes 8070–8078 and 8080–8083 between 2007 and 2016 were included and grouped into privately insured, Medicaid, and uninsured groups. Log-rank test and multivariable Cox's proportional hazard model were performed. Main Outcome Measures Tumor stage, age, sex, race, marital status, disease stage, year of diagnosis, median household county income, and disease-specific survival outcomes including cause of death were analyzed. Results Across all tumor stages, privately insured patients had a 59.0% lower mortality risk than uninsured patients (hazard ratio [HR]: 0.410, 95% confidence interval [CI]: [0.320, 0.526], p < 0.01). Medicaid patients were also estimated to have 19.0% lower mortality than uninsured patients (HR: 0.810, 95% CI: [0.626, 1.048], p = 0.108). Privately insured patients with regional and distant NPC had significantly better survival outcomes compared with uninsured individuals. Localized tumors did not show any association between survival and type of insurance coverage. Conclusion Privately insured individuals had significantly better survival outcomes than uninsured or Medicaid patients, a trend that was preserved after accounting for tumor grade, demographic and clinicopathologic factors. These results underscore the difference in survival outcomes when comparing privately insured to Medicaid/uninsured populations and warrant further investigation in efforts for health care reform.

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“…Most of the patients with advanced larynx cancer have locally advanced disease. 1 Advanced laryngeal cancer has a poor prognosis, and independent from the treatment method, 5-year survival rate is 39% to 60%. This is mostly because of being unable to control the regional and distant spread of the disease.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Extranodal Extension on Survival in Laryngeal Carcinoma

Bulğurcu¹,

İdil²,

Küçük³

et al. 2019

Ear Nose Throat J

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It is known that lymph node metastasis lowers the survival rates in laryngeal carcinoma. This study aimed to investigate the effect of extranodal extension in lymph node metastasis on survival. The demographic characteristics and histopathologic results of 81 patients who underwent total laryngectomy and neck dissection due to advanced larynx squamous cell carcinoma between 2011 and 2018 were reviewed retrospectively. The patients were divided into 3 groups by lymph node metastasis status as reactive lymph node (group 1), lymph node metastasis without detected extranodal extension (group 2), and lymph node metastasis with detected extranodal extension (group 3). Survival analysis was performed between these 3 groups. In the patient population with a mean age of 61.56 years consisting of 6 females and 75 males, demographic characteristics between groups were comparable. Overall survival (OS) rates were detected to be 81% in group 1, 69.2% in group 2, and 61.5% in group 3. Two-year OS rates were detected to be 66.7% in group 1, 46.2% in group 2, and 38.5% in group 3. Statistical difference was detected between group 1 and group 3 both for OS and 2-year OS ( P = .014, P = .008, respectively). No statistical difference was detected between group 2 and group 1, and between group 2 and group 3. In this study, we found a negative effect of detecting neck lymphadenopathy metastasis and extranodal extension on survival in patients who underwent total laryngectomy and neck dissection due to advanced laryngeal carcinoma.

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Efficacy of laryngectomy alone for treatment of locally advanced laryngeal cancer: A stage‐ and subsite‐specific survival analysis

Abstract: Locally advanced laryngeal cancer patients with T3 primaries, no nodal disease or primaries of the glottis may not benefit from post-operative radiotherapy when treated with primary total laryngectomy.

Cited by 6 publications

References 30 publications

pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients

pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients

Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis

The Effect of Extranodal Extension on Survival in Laryngeal Carcinoma

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