title: Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy.
abstract: Organ-sparing approaches with chemoradiotherapy are often used in the treatment of patients with laryngeal cancer, and the oncologic outcomes of these patients are similar to patients who undergo laryngectomy. However, chemoradiotherapy for laryngeal cancer patients with large or locally-invasive (T4) tumors has been more slowly incorporated due to concern for poor post-treatment function of the preserved larynx. Here, we characterize acute and long-term performance and quality-of-life (QOL) outcomes of T4 laryngeal cancer patients treated with induction chemotherapy followed by combined chemoradiotherapy. Using several validated metrics, we find patients experience a decline in most measures of performance and QOL during and immediately following treatment. However, the majority of patients improve to baseline over varying lengths of time following completion of treatment, and many go on to exceed pre-treatment levels of function. Gender, race, alcohol, and tobacco usage were found to be associated with differences in performance and QOL scores across time points. This study suggests that patients with advanced laryngeal tumors who historically had been considered poor candidates for organ-sparing treatment are able to return to, and in many cases exceed pre-treatment performance and QOL following induction chemotherapy and combined chemoradiotherapy.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States. Electronic address: kmouw@lroc.harvard.edu.
authors.forename: Kent W
authors.initials: KW
authors.lastname: Mouw
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States.
authors.forename: Abhishek A
authors.initials: AA
authors.lastname: Solanki
authors.affiliation: Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Kerstin M
authors.initials: KM
authors.lastname: Stenson
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States.
authors.forename: Mary Ellyn
authors.initials: ME
authors.lastname: Witt
authors.affiliation: Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Blair
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Ezra E W
authors.initials: EEW
authors.lastname: Cohen
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
authors.affiliation: Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Marcy
authors.initials: M
authors.lastname: List
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D060828:Induction Chemotherapy / Q000379:methods*; D007822:Laryngeal Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D016190:Carboplatin; D017239:Paclitaxel; D005472:Fluorouracil; D006918:Hydroxyurea