Salvage surgery after radiotherapy failure in T1–T2 squamous cell carcinoma of the glottic larynx

McLaughlin, Margaret; Parsons, James T.; Fein, Douglas A.; Stringer, Scott P.; Cassisi, Nicholas J.; Mendenhall, William M.; Million, Rodney R.

doi:10.1002/(sici)1097-0347(199605/06)18:3<229::aid-hed4>3.0.co;2-1

Cited by 95 publications

(60 citation statements)

References 25 publications

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“…4,6 Nevertheless, overall control of disease may reach 90% to 100% if surgical salvage is performed. 7,8 Currently available clinicopathologic markers, such as extension of disease into nearby structures, lymph node status, and positive surgical margins, are suitable for predicting prognosis. 9 Molecular markers have the potential to consistently select high-risk patients and label biologically aggressive disease.…”

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confidence: 99%

Prognostic significance of vascular endothelial growth factor protein levels in T1‐2 N0 laryngeal cancer treated with primary radiation therapy

Yang¹,

Haffty²

2006

Cancer

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BACKGROUND.The purpose of this study was to assess the prognostic value of vascular endothelial growth factor protein levels in a large cohort of patients with T1‐T2 N0 laryngeal cancer treated with primary radiation therapy (XRT).METHODS.Primary tumor specimens from a cohort of 123 patients with T1‐T2 N0 laryngeal cancer treated with XRT between 1975 and 2000 were constructed into a tissue microarray. Clinical prognostic factors included age, sex, T classification, and tumor subsite. Molecular prognostic factors included vascular endothelial growth factor, epidermal growth factor receptor, and p53 expression, determined by using immunohistochemistry on tissue microarrays. The association between vascular endothelial growth factor status, covariables, and outcome was assessed.RESULTS.With a median follow‐up of 9.9 years, 32 (26%) were diagnosed with local relapse (5‐year local relapse‐free rate, 70.4%). T2 tumor stage (31.7%) was a significant predictor of local relapse (relative risk [RR], 1.71; 95% confidence interval [CI], 1.21–2.43; P<.05). Positive expression of vascular endothelial growth factor, epidermal growth factor receptor, and p53 were: 8.5%, 58.7%, and 36.4%, respectively. In univariate analysis, vascular endothelial growth factor positivity was a significant predictor of overall survival (RR = 1.62; 95% CI, 0.99–2.42; P = .05). In multivariate analysis, positive vascular endothelial growth factor status maintained significant correlation with overall survival (RR, 2.79; 95% CI, 1.49–4.95; P = .002).CONCLUSIONS.Vascular endothelial growth factor positivity appeared to be a significant predictor of overall survival in a multivariate model. Further evaluation of vascular endothelial growth factor‐positive laryngeal cancers treated with primary XRT is warranted. Cancer 2007;109:566–573. © 2006 American Cancer Society.

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Prognostic significance of vascular endothelial growth factor protein levels in T1‐2 N0 laryngeal cancer treated with primary radiation therapy

Yang¹,

Haffty²

2006

Cancer

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“…The delay in diagnosis following failed radiotherapy results in tumour progression, which impacts significantly on patient survival. Salvage surgery is also associated with increased failure and complication rates due to operating in a previously irradiated field (McLaughlin et al, 1996).…”

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Bcl-2 expression predicts radiotherapy failure in laryngeal cancer

et al. 2005

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Early stage laryngeal cancer can be effectively cured by radiotherapy or conservative laryngeal surgery. In the UK, radiotherapy is the preferred first line treatment. However, up to 25% of patients with T2 tumours will demonstrate locally persistent or recurrent disease at the original site, requiring salvage surgery to achieve a definitive cure. Patients experiencing treatment failure have a relatively poor prognosis. A retrospective analysis was conducted consisting of 124 patients with early stage (T1 -T2, N0) laryngeal squamous cell carcinoma. In total, 62 patients who failed radiotherapy were matched for T stage, laryngeal subsite and smoking history to a group of 62 patients successfully cured by radiotherapy. Using immunohistochemistry the groups were compared for expression of apoptotic proteins: bcl-2, bcl-X L , bax, bak and survivin. Radioresistant laryngeal cancer was associated with bcl-2 (Po0.001) and bcl-X L (P ¼ 0.005) expression and loss of bax expression (P ¼ 0.012) in pretreatment biopsies. Bcl-2 has an accuracy of 71% in predicting radiotherapy outcome. The association between expression of bcl-2, bcl-X L and bax with radioresistant cancer suggests a potential mechanism by which cancer cells avoid the destructive effects of radiotherapy. Predicting radioresistance, using bcl-2, would allow the clinician to recommend conservative laryngeal surgery as an alternative first line treatment to radiotherapy.

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“…Unfortunately, in many instances, the recurrent tumor extends beyond its original site, and total laryngectomy is necessary. [13][14][15][16] However, in carefully selected cases, conservation surgery with preservation of a portion of the larynx is feasible. [17][18][19][20] Endoscopic laser surgery was recently proposed when conservation surgery is possible in cases of radiation-failure.…”

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Endoscopic laser surgery in the treatment of radiation failure of early laryngeal carcinoma

et al. 2000

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Salvage surgery after radiotherapy failure in T1–T2 squamous cell carcinoma of the glottic larynx

Cited by 95 publications

References 25 publications

Prognostic significance of vascular endothelial growth factor protein levels in T1‐2 N0 laryngeal cancer treated with primary radiation therapy

Prognostic significance of vascular endothelial growth factor protein levels in T1‐2 N0 laryngeal cancer treated with primary radiation therapy

Bcl-2 expression predicts radiotherapy failure in laryngeal cancer

Endoscopic laser surgery in the treatment of radiation failure of early laryngeal carcinoma

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