title: Management of advanced hypopharyngeal and laryngeal cancer with and without cartilage invasion.
abstract: OBJECTIVE
  To compare efficacy, in terms of disease control/survival in advanced hypopharyngeal and laryngeal lesions, according to treatment strategy (primary surgery, PS or primary chemoradiotherapy, CRT) and invasion pattern (cartilage, CAI or soft tissue involvement, STI).
  
  
  METHODS
  Records from 463 patients with T3 and T4a carcinoma with CAI (n=221) or STI (n=242) treated at a university clinic over 18 years were retrospectively reviewed.
  
  
  RESULTS
  Disease-specific survival (DSS) for the CAI group was 70.1% (PS) and 38.4% (CRT), and 76.6% and 46% for the STI group, respectively. Overall survival (OS) for STI was 56.4% (PS) and 30.6% (CRT), and for CAI 51.1% (PS) and 28.5% (CRT) respectively. Positive resection margins and regional neck metastases reduced survival. T3 lesions treated non-operatively still had significantly improved survival versus T4a by >20%.
  
  
  CONCLUSIONS
  Surgery remains an indispensable part of treatment in local advanced hypopharyngeal and laryngeal cancer with high survival results. It should be part of a concept that includes adjuvant (C)RT. For T3 lesions, primary CRT is also acceptable and CAI is not a contraindication for primary CRT. Regional disease is a strong prognostic factor. In spite of adjuvant treatment, DSS deteriorates by about 20% in cases with positive resection margins.
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany. Electronic address: claudia.scherl@uk-erlangen.de.
authors: Claudia
authors: C
authors: Scherl
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Konstantinos
authors: K
authors: Mantsopoulos
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Radiation Oncology, Universitätsstrasse 27, 91054 Erlangen, Germany.
authors: Sabine
authors: S
authors: Semrau
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Radiation Oncology, Universitätsstrasse 27, 91054 Erlangen, Germany.
authors: Rainer
authors: R
authors: Fietkau
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Markus
authors: M
authors: Kapsreiter
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Michael
authors: M
authors: Koch
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Maximilian
authors: M
authors: Traxdorf
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Philipp
authors: P
authors: Grundtner
authors: Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otorhinolaryngology - Head and Neck Surgery, Waldstrasse 1, 91054 Erlangen, Germany.
authors: Heinrich
authors: H
authors: Iro
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D002356:Cartilage / Q000473:pathology; D059248:Chemoradiotherapy / Q000379:methods*; D019468:Disease Management; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D007817:Laryngeal Cartilages / Q000473:pathology*; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D062606:Tertiary Care Centers
keywords: Cartilage; Chemoradiation; Head and neck cancer; Hypopharynx; Larynx; Squamous cell carcinoma