title: Survival outcome depending on different treatment strategies in advanced stages III and IV laryngeal cancers: an audit of data from two European centres.
abstract: In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery Sahlgrenska University Hospital, Gothenburg University, SE 413 45, Gothenburg, Sweden, therese.karlsson.06@aberdeen.ac.uk.
authors.forename: Therese R
authors.initials: TR
authors.lastname: Karlsson
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Azzawe
authors.forename: Luaay
authors.initials: L
authors.lastname: Aziz
authors.forename: David
authors.initials: D
authors.lastname: Hurman
authors.forename: Caterina
authors.initials: C
authors.lastname: Finizia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012606:Scotland; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin