Clinical Predictors of Laryngeal Preservation Rate in Stage III-IV Laryngeal Cancer and Hypopharyngeal Cancer Patients Treated with Organ Preservation

Document Type: Research Articles

Authors

1 Department of Radiation Oncology, Rajavithi Hospital, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.

2 Department of Otolaryngology, Head and Neck Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.

Abstract

Purpose: To determine factors affecting laryngeal preservation rate in laryngeal and hypopharyngeal cancer patients
treated with organ preservation. Material and Methods: Retrospective study examining stage III to IV laryngeal and
hypopharyngeal cancer patients who have been treated with organ preservation. Conventional radiation must be applied
in all patients with minimum dose of 45 Gray. Weekly or triweekly chemotherapy can be adding during radiation. Salvage
surgery should be considered in residual disease or local recurrence. Kaplan-Meier was used for survival analysis and,
Log rank test and Cox proportional hazard test were used for uni and multivariate analysis. Results: From January
2010 to October 2014, there were 69 patients treated with laryngeal preservation and 53 patients received radiation
dose 61-70 Gray. After completing radiation, we found that 44 patients have no residual tumor within 6 months and
33 patients can preserve their functional larynx later with complete response (median follow up 6 mo, range 0-46.3
mo). The 1-year, 2-year and 3-year laryngeal preservation rate was 49%, 36 % and 32 % respectively. On univariate
analysis, lower nodal stage (p = 0.008), stage III disease (p = 0.046), tumor volume cord involvement (p = 0.016), dose 61-70 Gray (p < 0.001) and no interruption of treatment (p = 0.017) have better
laryngeal preservation rates. ECOG performance status 2, higher nodal stage, stage IV, presence of true vocal cord
involvement, upper airway obstruction before/during radiation and radiation dose below 61-70 Gray had an effect on
worse overall survival when evaluated with univariate analysis statistical significance. Conclusion: For factors that
affected laryngeal preservation in our study were nodal stage, group stage, tumor volume, true vocal cord involvement,
radiation dose and treatment break time more than one week with statistical significance.

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