title: Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage III and IV disease.
abstract: OBJECTIVE
  To compare toxicity, survival and laryngeal preservation rate after radiotherapy alone (RR), radiotherapy after supraglottic horizontal laryngectomy (SHLR) and radiotherapy after total laryngectomy (TLR) for advanced supraglottic laryngeal cancer.
  
  
  METHODS
  From 1984 to 2012, 532 patients (pts) were treated in our Department: 273 were potentially fit for conservative surgery (Group I) and 259 were not amenable to partial surgery (Group II).
  
  
  RESULTS
  A younger age (p = 0.005), a better performance status (p < 0.001), the absence of comorbidities (p < 0.001) and the absence of nodal involvement (p = 0.006) favorably impacted on overall survival. More high-grade mucositis (p = 0.009), mild dysphagia (p < 0.001) and mild xerostomia (p < 0.001) were found in RR group; surgical patients had more edema of neck (p = 0.009) and skin toxicity (p = 0.008). Group I No differences in local, nodal and distant recurrences and in number of rescue laryngectomies were observed. The disease characteristics (T, N and stage) but not the treatment modality impacted on disease-free survival (DFS). Group II There was an higher number of local (p = 0.013) and nodal (p = 0.022) recurrences after RR. DFS (p = 0.01) was longer after TLR. No differences in DFS between TLR patients and RR patients who underwent radio-chemotherapy were found.
  
  
  CONCLUSIONS
  In Group I, RR results in a local-regional control and organ preservation comparable to surgical treatments, with only slight increase of late mild xerostomia and dysphagia. In Group II RR was less effective than TLR, with a significantly worse DFS. The use of concurrent radical radio-chemotherapy seems to provide comparable loco-regional control to TLR.
authors.affiliation: Radiation Oncology Department, 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, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.affiliation: Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Foscarini
authors.affiliation: Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Maddalo
authors.affiliation: Radiation Oncology Department, 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, 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, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Cavagnini
authors.affiliation: Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciccarelli
authors.affiliation: Radiation Oncology Department, 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, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.|Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
authors.affiliation: Radiation Oncology Department, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy. michela.buglione@unibs.it.|Radiation Oncology Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy. michela.buglione@unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Laryngeal preservation; Radiotherapy; Supraglottic larynx cancer; Survival; Toxicity