Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?

Ela Delikgöz Soykut; Eylem Odabasi; Nilgün Şahin; Ahmet Baran; Hakan Taban; Asude Unal

Makale detayları

Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?

Yazarlar:

Ela Delikgöz Soykut | Eylem Odabasi | Nilgün Şahin | Ahmet Baran | Hakan Taban | Asude Unal

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Radyoterapi

Dergi:

Journal of Medicine and Palliative Care Vol.4 Issue 4, pp.315-322

Belge Tipi:

Makale

Yayın Tarihi:

8/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297612

pISSN:

2717-7505

Anahtar kelimeler:

Özet:

 Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer LC with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy CRT is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy RTCRT as the standard treatment regimen after surgery. Methods: A retrospective review of T4 LC patients treated with CRT 17 patients and adjuvant RTCRT 26 patients between 2015 and 2021 was conducted. Overall survival OS, local regional recurrence-free survival LRRFS, and disease-free survival DFS were compared between the groups. The organ preservation rate was determined for the CRT group. Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9, 51.4, and 51.9, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group 35.3 vs. 70.2, p0.007; 22.1 vs. 75.1, p 0.001; 22.1 vs. 75.7, p0.001. With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE in the postoperative RT group, except LRRFS were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patients request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5 in the CRT group. Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patients request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.

 Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer LC with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy CRT is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy RTCRT as the standard treatment regimen after surgery. Methods: A retrospective review of T4 LC patients treated with CRT 17 patients and adjuvant RTCRT 26 patients between 2015 and 2021 was conducted. Overall survival OS, local regional recurrence-free survival LRRFS, and disease-free survival DFS were compared between the groups. The organ preservation rate was determined for the CRT group. Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9, 51.4, and 51.9, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group 35.3 vs. 70.2, p0.007; 22.1 vs. 75.1, p 0.001; 22.1 vs. 75.7, p0.001. With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE in the postoperative RT group, except LRRFS were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patients request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5 in the CRT group. Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patients request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.

 Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer LC with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy CRT is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy RTCRT as the standard treatment regimen after surgery. Methods: A retrospective review of T4 LC patients treated with CRT 17 patients and adjuvant RTCRT 26 patients between 2015 and 2021 was conducted. Overall survival OS, local regional recurrence-free survival LRRFS, and disease-free survival DFS were compared between the groups. The organ preservation rate was determined for the CRT group. Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9, 51.4, and 51.9, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group 35.3 vs. 70.2, p0.007; 22.1 vs. 75.1, p 0.001; 22.1 vs. 75.7, p0.001. With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE in the postoperative RT group, except LRRFS were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patients request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5 in the CRT group. Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patients request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.

 Amaç: Organ koruyucu yaklaşım, ileri evrede larinks kanseri LK için benzer sağkalım sonuçları ile kanıta dayalı bir tedavi seçeneği olarak önerilmektedir. Ancak T4 hastalıkta organ koruma yaklaşımı tartışmalıdır ve öncelikle cerrahi tedavi tercih edilmektedir. Bu çalışmanın amacı, kemoradyoterapi KRT ve postoperatif radyoterapi RTKRT uygulanan T4 LKli hastalarda tedavi sonuçlarını değerlendirmektir. Gereç ve Yöntem: 2015 ve 2021 yılları arasında KRT 19 hasta ve adjuvan RTKRT 27 hasta ile tedavi edilen T4 LK hastalarının retrospektif incelemesi yapılmıştır. Gruplar arasında genel sağkalım GS, lokal bölgesel rekürrenssiz sağkalım LBRS ve hastalıksız sağkalım HS karşılaştırıldı. KRT grubu için organ koruma oranı belirlendi. Bulgular: Tüm kohort için medyan takip süresi 39,5 aydı; 5 yıllık GS, LBRS, HS sırasıyla 52,5, 48,1 ve 48,1 idi. 5 yıllık GS, LBRS ve HS oranları açısından tedavi grupları arasında istatistiksel olarak anlamlı fark bulundu ve KRT grubunda sağkalımın azaldığı saptandı 31,6 vs 67,6, p0,004; 19,7 vs 72,3, p0,001; 19,7 vs 72,9, p0,001. Diğer klinikopatolojik faktörler açısından; çok değişkenli analizde yaş sadece GS üzerinde anlamlıydı, tümör boyutu, nodal evre ve ECE ameliyat edilen hastalarda GS, LBRS ve HS oranları ile bağlantılıydı. KRT grubunda 3 yıllık organ koruma oranı 81,5 idi. Sonuç: Cerrahi kolu, KRT grubuna kıyasla GS, LBRS, HS açısından istatistiksel olarak anlamlı derecede üstün sonuçlara sahipti. Bununla birlikte, KRT kolunda büyük ölçüde laringeal koruma gözlendi.

Makale detayları

Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?

Yazarlar:

Ela Delikgöz Soykut | Eylem Odabasi | Nilgün Şahin | Ahmet Baran | Hakan Taban | Asude Unal

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Radyoterapi

Dergi:

Journal of Medicine and Palliative Care Vol.4 Issue 4, pp.315-322

Belge Tipi:

Makale

Yayın Tarihi:

8/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297612

pISSN:

2717-7505

Laryngeal cancer

advanced stage

organ preservation

radiotherapy

laryngectomy

treatment outcomeLarinks kanseri

İleri evre

Organ koruma

Radyoterapi

Larenjektomi

Sonuç

Sayı

Makale detayları

Yazarlar: Ela Delikgöz Soykut | Eylem Odabasi | Nilgün Şahin | Ahmet Baran | Hakan Taban | Asude Unal

Yayıncı: MediHealth Academy Yayıncılık

Ana Başlıklar: Radyoterapi

Dergi: Journal of Medicine and Palliative Care Vol.4 Issue 4, pp.315-322

Belge Tipi: Makale

Yayın Tarihi: 8/2023

Belge Dili: İngilizce

Document ID (Org No.): 2001297612

pISSN: 2717-7505

Sayı

Yazarlar:

Ela Delikgöz Soykut | Eylem Odabasi | Nilgün Şahin | Ahmet Baran | Hakan Taban | Asude Unal

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Radyoterapi

Dergi:

Journal of Medicine and Palliative Care Vol.4 Issue 4, pp.315-322

Belge Tipi:

Makale

Yayın Tarihi:

8/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297612

pISSN:

2717-7505