Clinical predictors of laryngeal preservation rate in stage III-IV laryngeal cancer and hypopharyngeal cancer patients treated with organ preservation

Abstract

Purpose: To determine factors affecting laryngeal preservation rate in laryngeal and hypopharyngeal cancer patients treated with organ preservation. Material and Methods: Retrospective study examining stage III to IV laryngeal and hypopharyngeal cancer patients who have been treated with organ preservation. Conventional radiation must be applied in all patients with minimum dose of 45 Gray. Weekly or triweekly chemotherapy can be adding during radiation. Salvage surgery should be considered in residual disease or local recurrence. Kaplan-Meier was used for survival analysis and, Log rank test and Cox proportional hazard test were used for uni and multivariate analysis. Results: From January 2010 to October 2014, there were 69 patients treated with laryngeal preservation and 53 patients received radiation dose 61-70 Gray. After completing radiation, we found that 44 patients have no residual tumor within 6 months and 33 patients can preserve their functional larynx later with complete response (median follow up 6 mo, range 0-46.3 mo). The 1-year, 2-year and 3-year laryngeal preservation rate was 49%, 36 % and 32 % respectively. On univariate analysis, lower nodal stage (p = 0.008), stage III disease (p = 0.046), tumor volume < 10 ml (p = 0.005), no true vocal cord involvement (p = 0.016), dose 61-70 Gray (p < 0.001) and no interruption of treatment (p = 0.017) have better laryngeal preservation rates. ECOG performance status 2, higher nodal stage, stage IV, presence of true vocal cord involvement, upper airway obstruction before/during radiation and radiation dose below 61-70 Gray had an effect on worse overall survival when evaluated with univariate analysis statistical significance. Conclusion: For factors that affected laryngeal preservation in our study were nodal stage, group stage, tumor volume, true vocal cord involvement, radiation dose and treatment break time more than one week with statistical significance.