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Amy Y Chen - One of the best experts on this subject based on the ideXlab platform.
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temporal trends in the treatment of early and advanced stage Laryngeal Cancer in the united states 1985 2007
Archives of Otolaryngology-head & Neck Surgery, 2011Co-Authors: Amy Y Chen, Stacey A Fedewa, Jason ZhuAbstract:Objective To describe trends and 4-year survival rate of surgical and nonsurgical treatment for Laryngeal Cancer. Design Observational cross-sectional study. Patients A total of 131 694 cases of Laryngeal Cancer diagnosed from 1985 to 2007 identified from the National Cancer Database. Main Outcome Measures Primary treatment information, including radiation therapy (RT), chemoradiation (CRT), and curative intent surgery, were identified. The association between treatment and the patient's clinical and nonclinical variables was analyzed using univariate and multivariate statistics. The 4-year survival rate was generated through Kaplan-Meier estimates, and multivariate Cox proportional hazard models were used to generate hazard ratios. Results Among patients with early-stage Cancer, the proportion receiving primary surgery increased (from 20% in 1985 to 33% in 2007), whereas the use of RT decreased from 64% to 52%. Patients with early-stage Cancer who resided in areas with higher socioeconomic status (SES) zip codes, had private insurance, who were not African American, and who were treated at academic facilities were more likely to receive surgery. The 4-year survival rate for patients with early-stage Laryngeal Cancer treated with surgery was higher than the rate for those treated with RT (79% vs 71%). Among patients with advanced-stage Cancer, the use of CRT increased from less than 7% to 45%, whereas the use of total laryngectomy decreased from 42% to 32%. The use of CRT was more common among patients who resided in areas with higher SES zip codes, had private insurance, and who were younger. The 4-year survival rates for patients with advanced Laryngeal Cancer treated with total laryngectomy, CRT, and RT were 51%, 48%, and 38%, respectively. Factors associated with an increased risk of death from advanced Laryngeal Cancer included receiving CRT and race/ethnicity. Conclusions Among patients with early-stage Laryngeal Cancer, we observed an increasing proportion of primary surgical therapy during this study period. Among patients with advanced-stage Cancer, we observed an increasing proportion of CRT. Not only were clinical factors associated with type of treatment, but select sociodemographic elements were also associated with treatment. Further investigation as to the decision-making process of patients with different sociodemographic backgrounds will assist in mitigating the differences in survival for this group of patients.
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impact of treating facilities volume on survival for early stage Laryngeal Cancer
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Amy Y Chen, Alex Pavluck, Michael T Halpern, Elizabeth WardAbstract:Background Treatment at a high-volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from Laryngeal Cancer has not been examined previously. Methods A total of 11,446 early-stage Laryngeal Cancer patients (1996–1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04–1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69–0.80). Conclusion This study is the first to assess the relationship between survival and treatment volume in Laryngeal Cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
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health insurance and stage at diagnosis of Laryngeal Cancer does insurance type predict stage at diagnosis
Archives of Otolaryngology-head & Neck Surgery, 2007Co-Authors: Amy Y Chen, Andrew K Stewart, Michael T Halpern, Nicole M Schrag, Elizabeth WardAbstract:Objective To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage Laryngeal Cancer. Design Retrospective cohort study from the National Cancer Database, 1996-2003. Setting Hospital-based practice. Participants Patients with known insurance status diagnosed as having invasive Laryngeal Cancer at Commission on Cancer facilities (N = 61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage. Main Outcome Measures Overall stage of Laryngeal Cancer (early vs advanced) and tumor size (T stage) at diagnosis. Results Patients with advanced-stage Laryngeal Cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors. Conclusions Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced Laryngeal Cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.
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changes in treatment of advanced Laryngeal Cancer 1985 2001
Otolaryngology-Head and Neck Surgery, 2006Co-Authors: Andrew K Stewart, Amy Y Chen, Nicole M Schrag, Yongping Hao, Dana W Flanders, James L Kepner, Elizabeth WardAbstract:Objective In 1991, a randomized study was published and demonstrated that use of nonsurgical therapy (chemoradiation) provided similar survival to total laryngectomy (the gold standard) for patients with advanced-stage Laryngeal Cancer. The purpose of this study was to assess how treatment of advanced Laryngeal Cancer was influenced by such developments in non-surgical therapy. Study design Patterns of care study using National Cancer Database (1985-2001). Results The percentage of advanced-stage patients treated with chemoradiation increased from 8.3% to 20.8% while the proportion treated with radiation alone decreased from 38.9% to 23.0%. Use of chemoradiation increased at a significantly faster rate after the 1991 publication at both community Cancer centers and teaching research facilities. The use of total laryngectomy decreased slightly during this period. Conclusions The use of chemoradiation increased after the 1991 publication. It was impossible to determine from the NCDB whether additional patients who could benefit from chemo-RT were not offered or did not complete this treatment option. We recommend that treatment recommendations discussed at tumor boards be recorded in Cancer registries.
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outcomes analysis of voice and quality of life in patients with Laryngeal Cancer
Archives of Otolaryngology-head & Neck Surgery, 1998Co-Authors: Michael G Stewart, Amy Y Chen, Carol B StachAbstract:Objective To assess relationships between voice satisfaction and global quality of life in patients who have been treated for Laryngeal Cancer. Design Cross-sectional survey study. Setting Veterans Affairs Medical Center. Patients Eighty patients who had completed treatment for Laryngeal Cancer with either total laryngectomy (n=17), radiotherapy (n=24), or both (n=39). Main Outcome Measures Subscale scores on a general health status instrument (the Medical Outcomes Study 36-item short-form health survey), and a validated voice-specific functional status instrument (the Voice Handicap Index). Results Self-rated global health did not correlate significantly with emotional, functional, or physical voice handicap, although some subscales on the 36-item short-form health survey correlated with voice handicap scores. Global health status scores did not differ between patients who had undergone laryngectomy with a tracheoesophageal puncture and patients treated with radiotherapy only. Physical voice handicap scores did not differ significantly between those who underwent tracheoesophageal puncture and those who had radiotherapy, but emotional ( P =.07) and functional ( P =.01) handicap scores were lower in patients treated with radiotherapy. However, there was considerable overlap in voice handicap scores, with many patients who had had tracheoesophageal puncture showing less voice handicap than patients treated with radiotherapy. Conclusions These data demonstrate that health status is affected by other factors than voice handicap in patients with Laryngeal Cancer. In addition, there is a large amount of individual variation in voice handicap after treatment. These findings illustrate the need for prospective studies assessing voice handicap and quality of life after treatment for Laryngeal Cancer.
Eduardo M Diaz - One of the best experts on this subject based on the ideXlab platform.
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durable long term remission with chemotherapy alone for stage ii to iv Laryngeal Cancer
Journal of Clinical Oncology, 2009Co-Authors: Christopher F Holsinger, Merrill S Kies, Eduardo M Diaz, Ann M Gillenwater, Jan S Lewin, Lawrence E Ginsberg, Bonnie S Glisson, Adam S Garden, Nebil Ark, Heather LinAbstract:Purpose For patients with stage II to IV Laryngeal Cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation Laryngeal surgery (CLS). Our objectives were to study the sensitivity of Laryngeal Cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with Laryngeal Cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemoth...
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conservation Laryngeal surgery versus total laryngectomy for radiation failure in Laryngeal Cancer
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2006Co-Authors: Christopher F Holsinger, Etai Funk, Dianna B Roberts, Eduardo M DiazAbstract:Background. Total laryngectomy is the standard of care for surgical salvage of radiation failure in Laryngeal Cancer. However, the role of conservation Laryngeal surgery in this set- ting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radia- tion failure in patients who initially presented with T1 or T2 squa- mous Cancer of the larynx. Methods. A 21-year retrospective analysis of patients who received surgery at a single comprehensive Cancer center after definitive radiation therapy is reported. At recurrence, the pa- tients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation Laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary Laryngeal Cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after sur- gery was 69.4 months. Most patients with recurrence after radio- therapy required total laryngectomy (69.5%; 73/105). Conserva- tion Laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). Results. In 14 patients, local or regional recurrence devel- oped after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation la- ryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p ¼ .634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic Laryngeal Cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who under- went a conservation approach (p ¼ .011 by log-rank test). Conclusions. Although conservation Laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation Laryngeal surgery is an oncologically sound alter- native to total laryngectomy for these patients. V C 2006 Wiley
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conservation Laryngeal surgery versus total laryngectomy for radiation failure in Laryngeal Cancer
Meeting of the American Head and Neck Society, 2006Co-Authors: Christopher F Holsinger, Etai Funk, Dianna B Roberts, Eduardo M DiazAbstract:Background. Total laryngectomy is the standard of care for surgical salvage of radiation failure in Laryngeal Cancer. However, the role of conservation Laryngeal surgery in this setting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radiation failure in patients who initially presented with T1 or T2 squamous Cancer of the larynx. Methods. A 21-year retrospective analysis of patients who received surgery at a single comprehensive Cancer center after definitive radiation therapy is reported. At recurrence, the patients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation Laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary Laryngeal Cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after surgery was 69.4 months. Most patients with recurrence after radiotherapy required total laryngectomy (69.5%; 73/105). Conservation Laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). Results. In 14 patients, local or regional recurrence developed after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation Laryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p =.634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic Laryngeal Cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who underwent a conservation approach (p =.011 by log-rank test). Conclusions. Although conservation Laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation Laryngeal surgery is an oncologically sound alternative to total laryngectomy for these patients.
Christopher F Holsinger - One of the best experts on this subject based on the ideXlab platform.
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durable long term remission with chemotherapy alone for stage ii to iv Laryngeal Cancer
Journal of Clinical Oncology, 2009Co-Authors: Christopher F Holsinger, Merrill S Kies, Eduardo M Diaz, Ann M Gillenwater, Jan S Lewin, Lawrence E Ginsberg, Bonnie S Glisson, Adam S Garden, Nebil Ark, Heather LinAbstract:Purpose For patients with stage II to IV Laryngeal Cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation Laryngeal surgery (CLS). Our objectives were to study the sensitivity of Laryngeal Cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with Laryngeal Cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemoth...
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conservation Laryngeal surgery versus total laryngectomy for radiation failure in Laryngeal Cancer
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2006Co-Authors: Christopher F Holsinger, Etai Funk, Dianna B Roberts, Eduardo M DiazAbstract:Background. Total laryngectomy is the standard of care for surgical salvage of radiation failure in Laryngeal Cancer. However, the role of conservation Laryngeal surgery in this set- ting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radia- tion failure in patients who initially presented with T1 or T2 squa- mous Cancer of the larynx. Methods. A 21-year retrospective analysis of patients who received surgery at a single comprehensive Cancer center after definitive radiation therapy is reported. At recurrence, the pa- tients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation Laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary Laryngeal Cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after sur- gery was 69.4 months. Most patients with recurrence after radio- therapy required total laryngectomy (69.5%; 73/105). Conserva- tion Laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). Results. In 14 patients, local or regional recurrence devel- oped after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation la- ryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p ¼ .634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic Laryngeal Cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who under- went a conservation approach (p ¼ .011 by log-rank test). Conclusions. Although conservation Laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation Laryngeal surgery is an oncologically sound alter- native to total laryngectomy for these patients. V C 2006 Wiley
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conservation Laryngeal surgery versus total laryngectomy for radiation failure in Laryngeal Cancer
Meeting of the American Head and Neck Society, 2006Co-Authors: Christopher F Holsinger, Etai Funk, Dianna B Roberts, Eduardo M DiazAbstract:Background. Total laryngectomy is the standard of care for surgical salvage of radiation failure in Laryngeal Cancer. However, the role of conservation Laryngeal surgery in this setting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radiation failure in patients who initially presented with T1 or T2 squamous Cancer of the larynx. Methods. A 21-year retrospective analysis of patients who received surgery at a single comprehensive Cancer center after definitive radiation therapy is reported. At recurrence, the patients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation Laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary Laryngeal Cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after surgery was 69.4 months. Most patients with recurrence after radiotherapy required total laryngectomy (69.5%; 73/105). Conservation Laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). Results. In 14 patients, local or regional recurrence developed after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation Laryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p =.634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic Laryngeal Cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who underwent a conservation approach (p =.011 by log-rank test). Conclusions. Although conservation Laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation Laryngeal surgery is an oncologically sound alternative to total laryngectomy for these patients.
Elizabeth Ward - One of the best experts on this subject based on the ideXlab platform.
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impact of treating facilities volume on survival for early stage Laryngeal Cancer
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Amy Y Chen, Alex Pavluck, Michael T Halpern, Elizabeth WardAbstract:Background Treatment at a high-volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from Laryngeal Cancer has not been examined previously. Methods A total of 11,446 early-stage Laryngeal Cancer patients (1996–1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04–1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69–0.80). Conclusion This study is the first to assess the relationship between survival and treatment volume in Laryngeal Cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
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health insurance and stage at diagnosis of Laryngeal Cancer does insurance type predict stage at diagnosis
Archives of Otolaryngology-head & Neck Surgery, 2007Co-Authors: Amy Y Chen, Andrew K Stewart, Michael T Halpern, Nicole M Schrag, Elizabeth WardAbstract:Objective To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage Laryngeal Cancer. Design Retrospective cohort study from the National Cancer Database, 1996-2003. Setting Hospital-based practice. Participants Patients with known insurance status diagnosed as having invasive Laryngeal Cancer at Commission on Cancer facilities (N = 61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage. Main Outcome Measures Overall stage of Laryngeal Cancer (early vs advanced) and tumor size (T stage) at diagnosis. Results Patients with advanced-stage Laryngeal Cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors. Conclusions Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced Laryngeal Cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.
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changes in treatment of advanced Laryngeal Cancer 1985 2001
Otolaryngology-Head and Neck Surgery, 2006Co-Authors: Andrew K Stewart, Amy Y Chen, Nicole M Schrag, Yongping Hao, Dana W Flanders, James L Kepner, Elizabeth WardAbstract:Objective In 1991, a randomized study was published and demonstrated that use of nonsurgical therapy (chemoradiation) provided similar survival to total laryngectomy (the gold standard) for patients with advanced-stage Laryngeal Cancer. The purpose of this study was to assess how treatment of advanced Laryngeal Cancer was influenced by such developments in non-surgical therapy. Study design Patterns of care study using National Cancer Database (1985-2001). Results The percentage of advanced-stage patients treated with chemoradiation increased from 8.3% to 20.8% while the proportion treated with radiation alone decreased from 38.9% to 23.0%. Use of chemoradiation increased at a significantly faster rate after the 1991 publication at both community Cancer centers and teaching research facilities. The use of total laryngectomy decreased slightly during this period. Conclusions The use of chemoradiation increased after the 1991 publication. It was impossible to determine from the NCDB whether additional patients who could benefit from chemo-RT were not offered or did not complete this treatment option. We recommend that treatment recommendations discussed at tumor boards be recorded in Cancer registries.
Wolfgang Steiner - One of the best experts on this subject based on the ideXlab platform.
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organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced Laryngeal Cancer
Strahlentherapie Und Onkologie, 2009Co-Authors: Arno Olthoff, Wolfgang Steiner, Andreas Ewen, Hendrik A Wolff, Robert Michael Hermann, Hilke Vorwerk, Andrea Hille, Ralph M W Rodel, Clemens F Hess, Olivier PradierAbstract:Transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced Laryngeal Cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced Laryngeal Cancer treated with larynx-preserving TLM and adjuvant radiotherapy. From 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced Laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H&N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test. After a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL. TLM and adjuvant radiotherapy is a curative option for patients with locally advanced Laryngeal Cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced Laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL.
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transoral laser microsurgery for advanced Laryngeal Cancer
Archives of Otolaryngology-head & Neck Surgery, 2007Co-Authors: Michael L. Hinni, David G. Grant, John R. Salassa, Richard E. Hayden, Alexios Martin, Hans Christiansen, Bruce W. Pearson, Bruce H Haughey, Brian Nussenbaum, Wolfgang SteinerAbstract:Objective To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced Laryngeal Cancer. Design Prospective case series study. Setting Multi-institution (academic, tertiary referral centers). Patients A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. Interventions Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. Main Outcome Measures End points analyzed included Laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. Results The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. Conclusions In patients with advanced Laryngeal Cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.
