TY - JOUR
T1 - Treatment results and prognostic factors of advanced T3-4 laryngeal carcinoma
T2 - The University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience
AU - Nguyen-Tan, Phuc F.
AU - Le, Quynh Thu
AU - Quivey, Jeanne Marie
AU - Singer, Mark
AU - Terris, David J.
AU - Goffinet, Don R.
AU - Fu, Karen K.
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 2001/8/1
Y1 - 2001/8/1
N2 - Purpose: To review the UCSF-SUH experience in the treatment of advanced T3-4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival. Methods and Materials: We reviewed the records of 223 patients treated for T3-4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28-85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC. Results: The median follow-up was 41 months (range, 2-367 months) for all patients and 78 months (range, 6-332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT. Conclusion: Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels ≥ 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.
AB - Purpose: To review the UCSF-SUH experience in the treatment of advanced T3-4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival. Methods and Materials: We reviewed the records of 223 patients treated for T3-4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28-85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC. Results: The median follow-up was 41 months (range, 2-367 months) for all patients and 78 months (range, 6-332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT. Conclusion: Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels ≥ 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.
KW - Advanced laryngeal carcinoma
KW - Hemoglobin
KW - Prognostic factors
KW - Survival
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=0035425303&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035425303&partnerID=8YFLogxK
U2 - 10.1016/S0360-3016(01)01538-3
DO - 10.1016/S0360-3016(01)01538-3
M3 - Article
C2 - 11483326
AN - SCOPUS:0035425303
SN - 0360-3016
VL - 50
SP - 1172
EP - 1180
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -