title: Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage I and II disease.
abstract: OBJECTIVE
  To compare acute and late toxicities, survival, and laryngeal preservation after radiotherapy alone (RR) or radiotherapy after partial laryngectomy (PLR) in early supraglottic laryngeal cancer.
  
  
  METHODS
  From 1984 to 2012, 172 patients were treated in our department. We analyzed and compared toxicities (CTCAE v 4.0), overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), local relapse-free survival (LRFS), nodal relapse-free survival (NRFS), metastasis-free survival (MFS), and the number of salvage total laryngectomies.
  
  
  RESULTS
  Patients in the RR group were older (p = 0.05) and had more often comorbidities (p = 0.025); those in the PLR group had mostly T2 disease (p = 0.014). No difference in number of local, nodal, and distant recurrences was found. A higher incidence of late mild dry mouth in patients treated with RR (38 vs. 4 %, p = 0.000) was reported. At univariate analysis, only a younger age, a better performance status, and the absence of comorbidities favorably impacted on OS and DSS. No differences were found in DFS, LRFS, NRFS, MFS, and the number of rescue laryngectomies between the two groups. Younger age and a good performance status persisted as a predictive factor of better survival (OS and DSS) at multivariate analysis.
  
  
  CONCLUSIONS
  Radical radiotherapy appears to be a viable alternative to conservative surgery, even in elderly patients with poor performance status and comorbidities. Salvage laryngectomy in the RR group was compared favorably with those reported in other conservative surgery series and in the group treated postoperatively of our series.
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy. michela.buglione@unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Costa
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Foscarini
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Maddalo
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Ludovica
authors.initials: L
authors.lastname: Pegurri
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Pasinetti
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciccarelli
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Tonoli
authors.affiliation: Radiation Oncology Department, University and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Laryngeal preservation; Radiotherapy; Supraglottic larynx cancer; Survival; Toxicity
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