title: Use of concurrent chemoradiation in advanced staged (T4) laryngeal cancer.
abstract: OBJECTIVE
  Patients with advanced laryngeal cancer sometimes desire organ preservation protocols even if it portends a worse outcome.
  
  
  BACKGROUND
  To assess outcomes of patients with T4 laryngeal cancer treated with chemoradiation therapy.
  
  
  METHODS
  Case series with chart review at a tertiary university hospital. Twenty-four patients with T4 laryngeal cancer all declined total laryngectomy with adjuvant radiation as the primary treatment modality and alternatively received concurrent chemoradiation therapy. The primary outcome was overall survival. Secondary outcomes were rates of tracheotomy dependence, gastric tube dependence, and need for salvage laryngectomy.
  
  
  RESULTS
  All patients had T4 laryngeal disease, 71% had cartilage invasion and 59% had regional metastasis to the neck. Kaplan-Meier analysis determined 2-year and 5-year overall survival to be 64% and 59% respectively. The locoregional recurrence rate was 25%. The distant metastasis rate was 21%. The rate of salvage laryngectomy was 17%, which occurred at a mean of 56.5months after the original diagnosis. The rate of tracheotomy dependence was 33% while gastric tube dependence was 25%.
  
  
  CONCLUSIONS
  Advanced T4 laryngeal cancer, particularly with cartilage invasion, remains a surgical disease best treated with total laryngectomy and adjuvant radiation. This data may help guide patients and practitioners considering concurrent chemoradiation therapy for definitive treatment of advanced laryngeal cancer.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Wick
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Rod P
authors.initials: RP
authors.lastname: Rezaee
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Garcia-Jarchow
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Zender
authors.affiliation: Department of Medical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gibson
authors.affiliation: Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Pierre.Lavertu@uhhospitals.org.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lavertu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D057240:Patient Preference; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D016312:Treatment Refusal