The impact of treatment center on the outcome of patients with laryngeal cancer treated with surgery and radiotherapy

Abstract

For laryngeal cancer, surgical excision of the primary tumor should be undertaken with the aim of achieving tumor-free margins. Adequate pathological assessment of the specimen and the competency of the treatment center play a crucial role in achieving cure. The present study aimed to analyze the significance of place of surgery on the outcome of patients with laryngeal cancer who underwent surgical operation in other centers and were subsequently referred to Doküz Eylul University Head and Neck Tumour Group (DEHNTG) for postoperative irradiation. Patients were divided into three groups according to their place of surgery. The first group (Group I) consisted of patients who had their surgical operation at DEUH. Patients in the second group (Group II) were referred from centers with oncological surgical experience. The third group (Group III) consisted of patients referred from hospitals with no surgical teams experienced in head and neck cancer treatment. The clinical and pathological features of patients in these three groups were analyzed to assess the impact of place of surgery on clinical outcome as well as the prognostic factors for survival. The study population consisted of 253 patients who were treated between 1991 and 2006 with locally advanced laryngeal cancer according to the protocol of DEHNTG. The median follow-up was 48 (3-181) months. The 5 years overall, loco-regional disease-free and distant disease-free survivals were 66, 88 and 91%, respectively. When patients' clinical and histopathological features were analyzed for the impact of place of surgery, surgical margin positivity rates were found to be higher in Group III (P = 0.032), although the other two groups had more advanced clinical and pathological N stage disease (P = 0.012, P = 0.001). In multivariate analysis, older age (P < 0.0001), presence of perinodal invasion (P = 0.012), time interval between surgery and radiotherapy longer than 6 weeks (P = 0.003) and tumor grade (P = 0.049) were the most significant factors. For loco-regional failure-free survival, advanced clinical stage (P = 0.002), place of surgery (P = 0.031) and presence of clinical subglottic invasion (P = 0.029) were shown to be important prognostic factors. For distant metastasis-free survival, only pathological (+) lymph node status (P = 0.046) was a significant factor in multivariate analysis. The significance of place of surgery as well as other well-known prognostic factors underlines the importance of an experienced multidisciplinary treatment team if best results are to be obtained for the patient.

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

“…Our results of combined treatment in patients with laryngeal cancer do not differ from the outcomes that have been obtained over a period of 30 years in different cancer centres [6,7,11,14,15,18,20,21,22,23,24,25,26,27,28,29,30,31].…”

“…High rates of 5-year LC in patients with advanced laryngeal cancer after combined treatment were also achieved by Hinerman et al [29], Smee et al [30], and Akman et al [31]. Thus, many years of clinical experience clearly demonstrate that postoperative radiotherapy in patients with advanced laryngeal cancer is an effective treatment.…”

“…Thus, many years of clinical experience clearly demonstrate that postoperative radiotherapy in patients with advanced laryngeal cancer is an effective treatment. Numerous literature reports confirm that the main predictive factors are related to intraoperative and histopathological evaluation of the surgical specimen [13,16,17,18,19,21,29,31,32,33,34,35,36,37,38,39,40].…”

Improved outcomes in adjuvant radiotherapy for oral cavity carcinoma at an academic center: A matched‐pair analysis

“…Limited studies of HNSCC have shown improved outcomes for patients treated at high‐volume hospitals or specialized cancer centers compared to lower‐volume nonacademic treatment facilities . The current authors recently reported that HNSCC patients treated with postoperative adjuvant radiotherapy (RT) at an AC received a higher total RT dose, a higher fractional dose, and a less early termination of RT compared to those treated at non‐AC radiation treatment centers .…”

The prognostic value of tumor-stroma proportion in laryngeal squamous cell carcinoma

“…wall. Many unfavorable prognostic factors are defined for laryngeal carcinomas, including advanced stage, subglottic localization, high microscopic grade, high number and size of involved lymph nodes, and presence of extranodal extension, epidermal growth factor receptor expression, tumor budding and DNA aneuploidy (20)(21)(22)(23)(24)(25). In this study the prognostic value of TSP is investigated in laryngeal SCC for the first time, in a series of patients treated with surgery and radiotherapy.…”