title: Squamous cell carcinoma of the larynx with subglottic extension: is larynx preservation possible?
abstract: OBJECTIVE
  Squamous cell carcinoma of larynx with subglottic extension (sSCC) is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of larynx preservation in sSCC patients.
  
  
  METHODS
  Between 1996 and 2012, 197 patients with sSCC were treated at our institution and included in the analysis. Stage III-IV tumors accounted for 76%. Patients received surgery (62%), radiotherapy (RT) (18%), or induction chemotherapy (CT) (20%) as front-line therapy.
  
  
  RESULTS
  The 5-year actuarial overall survival (OS), locoregional control (LRC), and distant control rate were 59% (95% CI 51-68), 83% (95% CI 77-89), and 88% (95% CI 83-93), respectively, with a median follow-up of 54.4 months. There was no difference in OS and LRC according to front-line treatments or between primary subglottic cancer and glottosupraglottic cancers with subglottic extension. In the multivariate analysis, age > 60 years and positive N stage were the only predictors for OS (HR 2, 95% CI 1.2-3.6; HR1.9, 95% CI 1-3.5, respectively). A lower LRC was observed for T3 patients receiving a larynx preservation protocol as compared with those receiving a front-line surgery (HR 14.1, 95% CI 2.5-136.7; p = 0.02); however, no difference of ultimate LRC was observed according to the first therapy when including T3 patients who underwent salvage laryngectomy (p = 0.6). In patients receiving a larynx preservation protocol, the 5-year larynx-preservation rate was 55% (95% CI 43-68), with 36% in T3 patients. The 5-year larynx preservation rate was 81% (95% CI 65-96) and 35% (95% CI 20-51) for patients who received RT or induction CT as a front-line treatment, respectively.
  
  
  CONCLUSIONS
  Outcomes of sSCC are comparable with other laryngeal cancers when managed with modern therapeutic options. Larynx-preservation protocols could be a suitable option in T1-T2 (RT or chemo-RT) and selected T3 sSCC patients (induction CT).
authors.affiliation: Department of Radiotherapy, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.forename: P
authors.initials: P
authors.lastname: Blanchard
authors.forename: S
authors.initials: S
authors.lastname: Temam
authors.forename: M-M
authors.initials: MM
authors.lastname: Maison
authors.forename: F
authors.initials: F
authors.lastname: Janot
authors.forename: H
authors.initials: H
authors.lastname: Mirghani
authors.forename: F
authors.initials: F
authors.lastname: Bidault
authors.forename: J
authors.initials: J
authors.lastname: Guigay
authors.forename: A
authors.initials: A
authors.lastname: Lusinchi
authors.forename: J
authors.initials: J
authors.lastname: Bourhis
authors.forename: N
authors.initials: N
authors.lastname: Daly-Schveitzer
authors.forename: Y
authors.initials: Y
authors.lastname: Tao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005602:France / Q000453:epidemiology; D005931:Glottis / Q000528:radiation effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods / Q000706:statistics & numerical data*; D058958:Organs at Risk / Q000528:radiation effects*; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome