Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck.
OBJECTIVE
To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment.


METHODS
Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO2 laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B).


RESULTS
Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054).


CONCLUSIONS
In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy.
Pradier
Olivier
O
Department of Radiotherapy, University of Göttingen, Göttingen, Germany. opradier@gwdg.de
Christiansen
Hans
H
Schmidberger
Heinz
H
Martin
Alexios
A
Jäckel
Martin C
MC
Steiner
Wolfgang
W
Ambrosch
Petra
P
Kahler
Elke
E
Hess
Clemens F
CF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy / Q000601:surgery; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant
D006441:Hemoglobin A