Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer

Timmermans, Adriana J.; Lange, Charlotte A.H.; Bois, Josien A. de; Werkhoven, Erik van; Hamming‐Vrieze, Olga; Hilgers, Frans J. M.; Brekel, Michiel W. M. van den

doi:10.1002/lary.25567

Cited by 40 publications

(30 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only seven patients analyzed (12.3%) in their series had a laryngeal cancer, and no details were given on their outcomes. However, a significant association between the tumor volume and treatment outcome has been described in numerous studies and has been confirmed in laryngeal cancers for which the cartilaginous framework probably limits bulky tumor extension and a wide range of sizes . This is the main reason why we decided to focus on laryngeal cancers and to exclude hypopharyngeal neoplasms treated with a larynx preservation protocol.…”

Section: Discussionmentioning

confidence: 92%

Outcomes following laryngectomy refusal after insufficient response to induction chemotherapy

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 92%

Outcomes following laryngectomy refusal after insufficient response to induction chemotherapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…These toxicities appear associated with larger initial tumor volumes and with radiation effects that are intensified by chemotherapy. Tumor volume has also been implicated as an important prognostic factor in chemoradiation treatment of advanced laryngeal cancer and less important in surgical management 40,41 . This has led to a re-emphasis on use of primary total laryngectomy with appropriate voice rehabilitation as a good treatment alternative, particularly in patients with extensive T4a cancers, since swallowing function after treatment is often better and frequently quality of life outcomes are similar to larynx preservation 15,42,43 .…”

Section: Discussionmentioning

confidence: 99%

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

The introduction of chemoradiation for advanced laryngeal cancer led to a major paradigm shift in treatment as an alternative to laryngectomy. Despite widespread adoption, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed. A unique approach incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiation was studied to determine if improved survival could be achieved. Design From 2002–2012, we treated an unselected cohort of 247 patients with laryngeal cancer in an academic institution. Interventions Limited disease patients (n=94) underwent endoscopic resection (n=33; 35%), radiation (n=50; 53%) or chemoradiation for deeply invasive T2 lesions (n=11; 12%). For advanced disease (n=153), neoadjuvant chemotherapy for treatment selection (n=71; 46%), concurrent chemoradiation (n=50; 33%) or primary surgery (n=32; 21%) was recommended. Outcomes Propensity for treatment selection in advanced patients was modeled using logistic regression. Overall (OS) and disease specific survival (DSS) were analyzed with Cox proportional hazards models stratified by propensity score. Median follow was 48 months. Results Five-year OS and DSS was 75% (95% C.I. 68–81%) and 83% (77–88%), respectively for the entire cohort. DSS was 92% (83–97%) for patients with Stage I, II and 78% (69–84%) for patients with Stage III, IV disease. For advanced disease patients, 5-year OS (and DSS) ranged from 78% (91%) for surgery to 76% (79%) for neoadjuvant bioselection and 61% (66%) for primary chemoradiation. Propensity-adjusted multivariable Cox models controlling for known prognostic factors showed DSS was significantly improved in the neoadjuvant group compared to definitive chemoradiation [Hazard ratio 0.48, 95%CI: (0.29, 0.80), p=0.005]. DSS for the definitive surgery group was significantly better compared to the neoadjuvant bioselection group, [Hazard ratio 0.34, 95%CI: (0.14, 0.82), p=0.02]. Larynx preservation was achieved in 65% of advanced patients. Conclusions Exceptional survival rates were achieved with a bioselective treatment approach utilizing a single cycle of neoadjuvant chemotherapy. Excellent survival rates were also achieved in patients selected for primary surgery and both were better than with concurrent chemoradiation suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.

show abstract

“…Timmermans and co-workers found no significant difference in five-year OS between T3 LSCC (primarily treated by radiotherapy or chemoradiotherapy) and T4 LSCC (primarily treated by TLAR). In a subsequent study, Timmermans showed similar survival rates for T3 LSCC, regardless of the modality of primary treatment (TLAR, radiotherapy or chemoradiotherapy) [23]. Dziegielewski et al suggested a reassessment of current treatment guidelines based on data from The Alberta Cancer Registry showing superior survival in patients treated surgically for T3 and T4a LSCC compared to those treated non-surgically (radiotherapy and chemoradiotherapy) [24].…”

Section: Discussionmentioning

confidence: 99%

Impact of stage, management and recurrence on survival rates in laryngeal cancer

et al. 2017

View full text Add to dashboard Cite

A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983–2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.

show abstract

Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer

Abstract: 4.

Cited by 40 publications

References 15 publications

Outcomes following laryngectomy refusal after insufficient response to induction chemotherapy

Outcomes following laryngectomy refusal after insufficient response to induction chemotherapy

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Impact of stage, management and recurrence on survival rates in laryngeal cancer

Contact Info

Product

Resources

About