title: Clinical outcomes of 849 laryngeal cancers treated in the past 40 years: are we succeeding?
abstract: OBJECTIVE
  We analyzed the clinical outcomes of 849 laryngeal cancers treated in the past 40 years, which overlapped with the era of the global treatment shift.
  
  
  METHODS
  To compare the chronological outcomes, patients were divided into four groups according to their registration year as 1972-82, 1983-92, 1993-2002 and 2003-12; treatment trends, larynx preservation rate and overall survival rate were compared.
  
  
  RESULTS
  There were 104, 173, 253 and 319 patients registered in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. Five-year overall survival rates were 74, 76.5, 75.6 and 82.2% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. The five-year larynx preservation rates were 65.5, 75.7, 75.4 and 80.9% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively.
  
  
  CONCLUSIONS
  The number of patients treated at our institute increased, and the overall survival and larynx preservation rates exhibited favorable improvements over the past four decades. In the analysis of nonsurgical options, S1 combined radiotherapy showed superiority over concurrent chemoradiotherapy and radiotherapy in larynx preservation, and S1 combined radiotherapy, concurrent chemoradiotherapy and Tegafur Uracil combined radiotherapy showed superiority over radiotherapy in overall survival. In nonsurgical approaches, proper case selection is the key to success and may be much more important than pursuing radiotherapy dose escalation. In the analysis of surgical options, laser and supracricoid laryngectomy with cricohyoidoepiglottopexy contributed to larynx preservation in early- and intermediate-stage cancers, respectively. Supracricoid laryngectomy with cricohyoidoepiglottopexy demonstrated overall survival not worse than total laryngectomy, which is the prerequisite treatment basis for larynx preservation options. We must make extra efforts in pursuing an ideal balance between nonsurgical and surgical larynx preservation options.
authors.affiliation: *Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan. meijin@med.kitasato-u.ac.jp.
authors.forename: Meijin
authors.initials: M
authors.lastname: Nakayama
authors.forename: Makito
authors.initials: M
authors.lastname: Okamoto
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishiyama
authors.forename: Shouko
authors.initials: S
authors.lastname: Komori
authors.forename: Tabito
authors.initials: T
authors.lastname: Okamoto
authors.forename: Yutomo
authors.initials: Y
authors.lastname: Seino
authors.forename: Koichi
authors.initials: K
authors.lastname: Kano
authors.forename: Itaru
authors.initials: I
authors.lastname: Soda
authors.forename: Akane
authors.initials: A
authors.lastname: Sekiguchi
authors.forename: Shogo
authors.initials: S
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: functional organ preservation; laryngeal cancer; larynx preservation