title: What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients.
abstract: OBJECTIVE
  To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor.
  
  
  METHODS
  A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied.
  
  
  RESULTS
  The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy.
  
  
  CONCLUSIONS
  We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
authors: Daniela
authors: D
authors: Alterio
authors: Mohssen
authors: M
authors: Ansarin
authors: Barbara A
authors: BA
authors: Jereczek-Fossa
authors: Stefano
authors: S
authors: Zorzi
authors: Luigi
authors: L
authors: Santoro
authors: Dario
authors: D
authors: Zerini
authors: Mariangela
authors: M
authors: Massaro
authors: Elena
authors: E
authors: Rondi
authors: Silvia
authors: S
authors: Ferrario
authors: Gaia
authors: G
authors: Piperno
authors: Maria
authors: M
authors: Cossu Rocca
authors: Mara
authors: M
authors: Griseri
authors: Lorenzo
authors: L
authors: Preda
authors: Fausto
authors: F
authors: Chiesa
authors: Roberto
authors: R
authors: Orecchia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods*; D007830:Larynx / Q000503:physiopathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D020127:Recovery of Function; D012189:Retrospective Studies; D014139:Tracheostomy; D016896:Treatment Outcome