Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?

Authors : Ela DELİKGÖZ SOYKUT, Eylem ODABASİ, Nilgün ŞAHİN, Ahmet BARAN, Hakan TABAN, Asude UNAL

Pages : 315-322

Doi:10.47582/jompac.1314922

View : 58 | Download : 44

Publication Date : 2023-08-30

Article Type : Research Paper

Abstract :Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer insert ignore into journalissuearticles values(LC); with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy insert ignore into journalissuearticles values(CRT); is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy insert ignore into journalissuearticles values(RT);/CRT as the standard treatment regimen after surgery. Methods: A retrospective review of T4 LC patients treated with CRT insert ignore into journalissuearticles values(17 patients); and adjuvant RT/CRT insert ignore into journalissuearticles values(26 patients); between 2015 and 2021 was conducted. Overall survival insert ignore into journalissuearticles values(OS);, local regional recurrence-free survival insert ignore into journalissuearticles values(LRRFS);, and disease-free survival insert ignore into journalissuearticles values(DFS); were compared between the groups. The organ preservation rate was determined for the CRT group. Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9%, 51.4%, and 51.9%, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group insert ignore into journalissuearticles values(35.3% vs. 70.2%, p=0.007; 22.1% vs. 75.1%, p= 0.001; 22.1% vs. 75.7%, p=0.001);. With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE insert ignore into journalissuearticles values(in the postoperative RT group, except LRRFS); were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patient’s request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5% in the CRT group. Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patient’s request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.
Keywords : Larinks kanseri, İleri evre, Organ koruma, Radyoterapi, Larenjektomi, Sonuç

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