title: Multimodal treatment for t1-2 supraglottic cancer: the impact of tumor location.
abstract: OBJECTIVE
  To examine the outcome and prognostic factors after multimodal treatment of T1-2 supraglottic cancer.
  
  
  METHODS
  We analyzed 49 patients with T1-2 supraglottic cancer who received multimodal treatment between 1990 and 2011. Their age range was 43-86 years (median=66 years). Fifteen patients had a T1 tumor and 34 had a T2 tumor (40 N0, 3 N1, 4 N2, and 2 N3). Debulking using transoral laser excision was employed in 25 patients. Neck dissection was performed in four patients. Chemotherapy was administered to 29 patients: intra-arterial infusion in four and systemic infusion in 25. Radiotherapy was administered at a median dose of 64.8 Gy (range=30-70 Gy) with once- or twice-daily fractionation. Median follow-up time was 60 months (range=12-153 months).
  
  
  RESULTS
  Two patients interrupted radiotherapy because of a poor response at 30 Gy (T2N2) and 49.9 Gy (T2N0). They underwent total laryngectomy and were still alive without any evidence of cancer 48 and 28 months after treatment, respectively. The other 47 patients (96%) had a complete local response to treatment. Locoregional failure was observed in six tumor sites, and one patient had simultaneous locoregional recurrence. The 5-year local control, disease-free, overall survival, and laryngeal preservation rates were 82%, 74%, 82%, and 90%, respectively. The location of a primary tumor within the supraglottis (epilarynx or elsewhere) was identified as the only factor predictive of progression-free survival by univariate and multivariate analyses (p=0.04). Acute adverse reactions of grade 3 or more were: one grade 3 laryngeal edema, one grade 3 dyspnea, and one grade 5 hematological toxicity (disseminated intravascular coagulation). Among late adverse events, one grade 1, one grade 2 hoarseness, and grade 3 laryngeal necrosis were observed.
  
  
  CONCLUSIONS
  Multimodal radiotherapy produced a good outcome. Localization of the tumor in the epilarynx was associated with a better progression-free survival rate than that in the other parts of the supraglottis.
authors.affiliation: Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566, Japan. hideya10@hotmail.com.
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Etsuyo
authors.initials: E
authors.lastname: Ogo
authors.forename: Toshi
authors.initials: T
authors.lastname: Abe
authors.forename: Naofumi
authors.initials: N
authors.lastname: Hayabuchi
authors.forename: Hirohito
authors.initials: H
authors.lastname: Umeno
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakashima
authors.forename: Satoaki
authors.initials: S
authors.lastname: Nakamura
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Supraglottic cancer; epilarynx; larynx preservation; radiotherapy