title: Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation.
abstract: The 5-year overall survival (OS) of loco-regionally advanced laryngeal and hypopharyngeal carcinoma (LA-LHC) has declined over the past two decades following the wide application of non-surgical approaches. We aimed to define the new role of open surgery combined with adjuvant chemoradiotherapy in the treatment of LA-LHC for improving survival while maintaining a functional larynx. In the current study, 90 LA-LHC patients treated with open surgery followed by postoperative RT/CRT in our institute from May 2005 to December 2012 were retrospectively analyzed. OS, disease-free survival (DFS), loco-regional failure-free survival (LRFFS) and distant metastasis-free survival (DMFS) were calculated, and prognostic factors were analyzed. Functional larynx preservation results were evaluated according to the head and neck quality of life (QoL) Scale. With a median follow-up period of 37 months, the 3- and 5-year OS, DFS, LRFFS and DMFS were 71.3, 63.7, 85.9, 73.7 and 55.9, 53.0, 81.6, 71.9 %, respectively. Vascular embolism and extracapsular extension (ECE) of the lymph nodes were prognostic factors for poorer OS (p = 0.045 and 0.046, respectively). Vascular embolism was the only prognostic factor for poorer DMFS (p = 0.005). Patients who underwent a conservative partial laryngectomy (CPL) experienced a higher QoL in the domains of speech, swallowing and emotion. Functional larynx preservation was achieved in 36/45 patients (80 %) who received CPL. The results of our study demonstrated that CPL followed by adequate adjuvant therapy could achieve superior oncological results compared with non-surgical approaches in LA-LHC patients while also maintaining satisfactory functional larynx in a majority of patients.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qian
authors.forename: Guopei
authors.initials: G
authors.lastname: Zhu
authors.forename: Yulong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiaoshen
authors.initials: X
authors.lastname: Wang
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Ji
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Shengjin
authors.initials: S
authors.lastname: Dou
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D014139:Tracheostomy