T₃Laryngeal cancer: a retrospective study of the Dutch Head and Neck Oncology Cooperative Group: study design and general results

Abstract

511 Patients with T3 N0-3 M0 squamous cell carcinoma of the larynx, treated in the Netherlands from 1975 until 1984, were retrospectively analysed. Four different treatment policies were followed: primary surgery, planned combination of radiotherapy and surgery, primary radical radiotherapy, and selective radiotherapy. General results are presented. Local control rate was 72%. Regional control rate was 90% for clinically N0 patients and 78% for clinically N+ patients. Salvage therapy was overall successful in 38%. Surgical salvage for local radiation failures (with regional relapse) was successful in 69%, and for regional failures (without local relapse) in 46%. Ultimate locoregional control was 78% and, due to 8% distant metastases, 5-year actuarial corrected survival was 70%. Prognosis did not improve over the years. Corrected survival was independently correlated with tumour extension, involvement of neck nodes and treatment strategy. Corrected survival was similar for primary radiotherapy and primary surgery, but significantly better for planned combined therapy. Multiple primary tumours occurred significantly more often in male (19.5%) than in female patients (7.3%) (P = 0.05), the bronchus being most commonly affected. Cumulative actuarial risk for metachronous tumour was 15% after 5 years and 30% after 10 years so prevention and early detection of these second tumours may play the most important role in improving overall survival rates in the future.

F‐18‐fluoro‐deoxy‐glucose positron‐emission tomography scanning in detection of local recurrence after radiotherapy for laryngeal/ pharyngeal cancer

“…Most local recurrences are seen in the first 2 years after radiotherapy, 12 coinciding with the period of risk for edema. It may be difficult to distinguish between edema and a local recurrence, as the latter may lie deep beneath apparently normal mucosa.…”

Surgical Treatment of the Neck in Cancer of the Larynx

“…The use of primary irradiation to treat these patients, however, makes it impossible to establish whether there were metastases in the treated lymph nodes [29], and therefore makes it difficult to compare the efficacy of elective neck dissection versus elective neck irradiation. Another disadvantage of irradiation is that surgical treatment retains the ability to employ subsequent radiotherapy for second primary tumors, which develop in 11-19% of patients with cancer of the larynx [19,[30][31][32][33], most often within the first 5 years after treatment [34].…”

A nationwide study of the epidemiology, treatment and survival of oropharyngeal carcinoma in the Netherlands

“…The Dutch Head and Neck Cooperative Group has chosen this approach, realizing that some ques tions would remain unanswered but certain useful insights would be obtained. Earlier studies of the group have al ready clearly shown this [19].…”

“…the University Hospitals of Groningen, Leiden and Maastricht in combination with the Radiotherapeutic Institute of Limburg, Nijmegen and Rotterdam in co operation with the Dr. Daniel Den Hoed Cancer Center, Utrecht and The Netherlands Cancer Institute in combination with the Uni versity of Amsterdam, have participated in the present project. In the preparatory phase, feasibility and scope of the study, time schedule and practical aspects were examined using previous ex periences of the Cooperative Group [19]. Next, a checklist and re lated manual were designed for the purposes of the study.…”