In: BMC Cancer, 17 (2017), Nr. 609. S. 1-9. ISSN 1471-2407
Vorschau |
PDF, Englisch
Download (490kB) | Lizenz: ![]() |
Abstract
Background: Larynx preservation (LP) is recommended for up to low-volume T4 laryngeal cancer as an evidence-based treatment option that does not compromise survival. However, a reevaluation of the current literature raises questions regarding whether there is indeed reliable evidence to support larynx preservation for T4 tumor patients. Methods: In an observational cohort study of 810 laryngeal cancer patients, we evaluated the outcomes of all T4 tumor patients treated with primary chemo-radiotherapy (CRT) or primary radiotherapy alone (RT) compared with upfront total laryngectomy followed by adjuvant (chemo)radiotherapy (TL + a[C]RT). Additionally, we reevaluated the studies that form the evidence base for the recommendation of LP for patients with up to T4 tumors (Pfister et al., J Clin Oncol 24:3693–704, 2006). Results: The evaluation of all 288 stage III and IV patients together did not show a significant difference in overall survival (OS) between CRT-LP and TL + a(C)RT (hazard ratio (HR) 1.23; 95% confidence interval (CI): 0.82–1.86; p = 0.31) using a multivariate proportional hazard model. However, a subgroup analysis of T4 tumor patients alone (N = 107; 13.9%) revealed significantly worse OS after CRT compared with TL + a(C)RT (HR 2.0; 95% CI: 1.04–3.7; p = 0.0369). A reevaluation of the subgroup of T4 patients in the 5 LP studies that led to the ASCO clinical practice guidelines revealed that only 21–45 T4 patients had differential data on survival outcome. These data, however, showed a markedly worse outcome for T4 patients after LP. Conclusions: T4 laryngeal cancer patients who reject TL as a treatment option should be informed that their chance of organ preservation with primary conservative treatment is likely to result in a significantly worse outcome in terms of OS. Significant loss of survival in T4 patients after LP is also confirmed in recent literature.
Dokumententyp: | Artikel |
---|---|
Titel der Zeitschrift: | BMC Cancer |
Band: | 17 |
Nummer: | 609 |
Verlag: | BioMed Central; Springer |
Ort der Veröffentlichung: | London; Berlin; Heidelberg |
Erstellungsdatum: | 21 Sep. 2017 12:09 |
Erscheinungsjahr: | 2017 |
ISSN: | 1471-2407 |
Seitenbereich: | S. 1-9 |
Institute/Einrichtungen: | Medizinische Fakultät Heidelberg und Uniklinikum > HNO-Universitätsklinik
Medizinische Fakultät Heidelberg und Uniklinikum > Heidelberg Institute for Global Health (HIGH) |
DDC-Sachgruppe: | 610 Medizin |