T2 laryngeal carcinoma with impaired mobility: subtypes with therapeutic implications

The aim of this study was to evaluate the outcome in the treatment of T2 laryngeal carcinoma with impaired laryngeal mobility, comparing surgical management to radiotherapy in terms of local control and survival. The files of 66 patients treated between 1988 and 1994 were retrospectively studied for tumor location, treatment and outcome. Forty-two patients were treated surgically and 24 by radiotherapy. Follow-up averaged 8.5 years. Local recurrence occurred in 12.5% of the cases treated by conservation laryngeal surgery and in 21% of the cases by radiotherapy. Ultimate laryngeal preservation was achieved in 90.9% of the cases initially treated by partial laryngectomy and in 87.5% of the cases treated by radiotherapy. Five-year actuarial survival rates were 90% and 28%, respectively. A higher rate of metastases and second primaries occurred in the group treated by radiotherapy. T2 laryngeal carcinoma amenable to partial laryngectomy had a higher local control rate than the cases not amenable to conservation surgery and treated by radiotherapy. Tumors differed in the two treatment groups in location and extensions, despite the fact that all were T2 tumors. We emphasize the limits of retrospective studies. Only prospective randomized studies will determine the true results of surgery versus radiotherapy for a homogeneous subset of T2 laryngeal tumors. Received: 17 May 2001 / Accepted: 21 August 2001     

Results of an organ preservation protocol with induction chemotherapy and radiotherapy in patients with locally advanced laryngeal carcinoma

An alternative treatment in patients with advanced laryngeal carcinoma who are candidates for total laryngectomy is induction chemotherapy and radical radiotherapy in an organ preservation approach. We conducted a study to evaluate results of this treatment in patients with locally advanced laryngeal carcinoma, candidates for total laryngectomy, who were treated at a single institution between 1985 and 1997. During the study period, 224 began treatment with induction chemotherapy. Induction chemotherapy consisted of three cycles of cisplatin and 5-fluoruracil in the majority of cases. Four patients died as a consequence of complications associated with chemotherapy treatment. Subsequent treatment consisted of total laryngectomy in 79 patients and radical radiotherapy in 141. After radical radiotherapy, local control for patients who achieved a complete response after induction chemotherapy was 74%, significantly better than 57% in patients with a non-complete response (P=0.04). Considering the initial group of 224 patients, the frequency of organ preservation was 39%. Considering only the patients treated with induction chemotherapy and radiotherapy, the organ preservation frequency was 62%. In a multivariate study, only the response after induction chemotherapy was significantly related to organ preservation.This paper was presented at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, Florida, 18–21 May 2002.     

Cost comparison of surgery vs organ preservation for laryngeal cancer

OBJECTIVE: To perform a cost minimization analysis of total laryngectomy with postoperative radiotherapy vs induction chemotherapy with subsequent radiotherapy in patients with advanced (stage III or IV) squamous cell carcinoma of the larynx. DESIGN: Decision-analysis model using data from peer-reviewed trials, case series, meta-analyses, and Medicare diagnosis related group reimbursement rates. SETTING AND PATIENTS: A hypothetical cohort of patients with stage III or IV laryngeal cancer. The perspective is that of a health care payer. INTERVENTIONS: The hypothetical patient cohort could receive (1) surgery (total laryngectomy) with postoperative radiotherapy or (2) induction chemotherapy (fluorouracil and cisplatin) with radiotherapy followed by salvage surgery for patients failing to respond to chemotherapy. MAIN OUTCOME MEASURE: Overall difference in direct medical costs in 2003 US dollars between the 2 treatment arms from initiation to completion of treatment. RESULTS: In the baseline analysis, the direct medical costs for the surgical arm were 30,138 US dollars per patient. For the organ preservation arm, the direct medical costs were 33,052 US dollars per patient. The finding that the surgical arm costs were lower was robust to all sensitivity analyses except for the extreme low estimate for the cost of chemotherapy. CONCLUSIONS: Our results suggest that total laryngectomy with postoperative radiotherapy costs nearly 3000 US dollars less than organ preservation treatment for advanced laryngeal cancer. Given that survival appears equivalent between the 2 modalities, cost consideration and patient preference may be important factors in decision making for the treatment of advanced laryngeal cancer.     

Organ preservation in laryngeal and hypopharyngeal cancer

Organ preservation in advanced laryngeal and hypopharyngeal squamous cell carcinoma has been a major target for clinical research in the last years. For a long time, partial surgery and radiotherapy were the only options that could preserve the larynx. Partial surgery has developed new open techniques and, with the introduction of laser it continues to have a clear role in organ preservation. Radiotherapy seeks better results with the use of altered fractions. But, the real revolution began after 1980 with the introduction of chemotherapy that increased the options. Induction chemotherapy followed by radiotherapy where response is good has allowed the larynx to be preserved in about half of the cases, without jeopardizing survival. Concomitant chemoradiotherapy gives better results in preservation, and induction chemotherapy followed by concomitant chemoradiotherapy is under clinical research. Finally, new targeted treatments open up new fields in clinical research. With so many options and in view of the lack of a global agreement, more multidisciplinary clinical research is still needed in order to define the best strategy for each patient.     

Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx--results of a pilot study.

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.     

Conservative Surgery in T3–T4 Pharyngolaryngeal Squamous Cell Carcinoma: An Alternative to Radiation Therapy and to Total Laryngectomy for Good Responders to Induction Chemotherapy

Objective To evaluate the possibility of preservation of the larynx after neoadjuvant chemotherapy by performing a conservative surgery instead of total laryngectomy initially planned, in patients with previously untreated laryngeal and piriform sinus squamous cell carcinoma (SCC). Study Design Retrospective study. Methods A total of 115 patients treated at Tenon Hospital with induction chemotherapy from 1985 to 1995, all with initial indication of radical surgery, were available for the study. The clinical tumor response was evaluated after three cycles of chemotherapy. According to this response, to preserve laryngeal functions, some patients had a modification of the treatment initially planned: radiation therapy essentially for complete responders, and conservative surgery for some partial responders. Results Of 69 patients with laryngeal cancer, 14 were treated by partial laryngectomy and 19 by radiation therapy; of 46 patients with piriform sinus cancer, 8 were treated by partial surgery and 12 by radiation therapy; the other patients were treated as was initially planned (total laryngectomy with partial pharyngectomy). Overall survival rates, estimated by the Kaplan‐Meier method, were not statistically different between the three treatment groups. The laryngeal functions were preserved in 54% of the patients who were alive at 3 years. Conclusion This report is a retrospective study, but these results suggest the possibility of using conservative surgery, instead of initially planned total laryngectomy, for good responders to induction chemotherapy with a small residual tumor.     

保留喉功能的梨状窝癌的综合治疗

探讨综合治疗对保留喉功能的梨状窝癌的作用。方法：对梨状窝癌进行保留喉功能治疗的３３例进行回顾性分析。（１）３３例术前分别给予１周期或２周期诱导化疗;（２）手术治疗经化疗后的肿瘤切除;（３）术后放射治疗。结果：化疗后有效率４２．４％。３年生存率５４．８％,５年生存率３８．７％。     

Results of an organ preservation protocol with induction chemotherapy and radiotherapy in patients with locally advanced pyriform sinus carcinoma

An alternative to the classical treatment for locally advanced (T3-T4 stage) pyriform sinus carcinoma with surgery and postoperative radiotherapy is to begin treatment with induction chemotherapy in an organ preservation approach. In patients with complete clinical response, this treatment is followed by radiotherapy; in non-complete responders, it is followed by surgery and postoperative radiotherapy. We conducted a retrospective study to evaluate such treatment in a cohort of 78 patients with locally advanced pyriform sinus carcinoma treated at a single institution between 1985 and 1997. In all patients, induction chemotherapy with cisplatin and 5-fluoruracil was carried out. Two patients died as a consequence of complications associated with chemotherapy treatment. Of the 76 patients who completed treatment, 23 (30%) achieved a complete response at the primary site, 38 (50%) attained a partial response, and 15 patients (20%) had a stabilization-progression. The 5-year adjusted survival of patients treated with radiotherapy alone was 57% and, in patients treated with surgery, 51%. There were no significant differences in survival related to the subsequent treatment used (P > 0.05). The larynx was preserved in 14 of the 23 patients (61%) who completed treatment with induction chemotherapy and radiotherapy. The frequency of organ preservation for the group of 78 patients who began treatment with induction chemotherapy was 18%. Received: 20 October 2000 / Accepted: 28 June 2001     

Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation

BACKGROUND: The incorporation of chemotherapy and radiation, either sequentially or concurrently, has been increasingly used for organ preservation in patients with advanced laryngeal cancer. Traditional outcome measures of clinical response such as locoregional control and survival have been similar for patients treated with chemoradiotherapy and those treated with total laryngectomy (TL). The impact of concurrent chemoradiotherapy for laryngeal preservation on the overall quality of life (QOL) of patients has not been clearly evaluated, particularly in direct comparison with TL. OBJECTIVE: To compare the QOL of patients treated with concurrent chemoradiotherapy with those treated with TL. DESIGN: Nonrandomized, retrospective, cross-sectional study. SETTING: Academic tertiary care referral center. METHODS: The study included 42 patients with advanced stage III or IV cancer of the larynx, who were treated with either concurrent chemoradiotherapy or TL with postoperative radiation therapy. Patients had to be without evidence of recurrence and to have completed therapy at least 3 months prior to inclusion in the study. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) in tandem with the head and neck module (EORTC QLQ-H&N35). RESULTS: On the core questionnaire (QLQ-C30), there were no statistically significant differences in the overall QOL score between the 2 groups. Functional subscale analysis revealed a trend for patients in the surgery and radiotherapy group to experience greater difficulties with social functioning (P =.18) relative to the chemoradiation group. On the QLQ-H&N35, surgery patients reported significantly greater difficulties with sensory disturbances (smell and taste, P =.001), use of painkillers (P =.049), and coughing (P =.004). On the other hand, chemoradiation patients reported significantly greater problems with dry mouth (P =.02). CONCLUSIONS: Both chemoradiation and TL affect, albeit differently, the QOL of patients treated for advanced cancer of the larynx. Although these differences can be detected by functional and subscale analysis, the overall QOL scores of both groups seem similar.     

Epidermoid carcinoma larynx in stage IV

ObjectiveTo determine the survival, loco-regional control, distant metastases and second primary in stage IV laryngeal carcinoma treated by surgery and radiotherapy.MaterialRetrospective study of 147 patients treated with surgery and radiotherapy with a 5 year minimun follow-up.ResultsOverall and cause specific survival at 5 and 10 years was 42%, 35% and 49%, 45.8% respectively. Loco-regional control was 57.7 % and 54.7% at 5 and 10 years. Local recurrences presented in 25.7%, regional recurrences in 74.2%, and distant metastases 10.9%. Second primary tumors developed in 12% of the patients, 50% of the cases in the lungs. Factors related to survival are evaluated.ConclusionsIn our experience, surgery with postoperative radiotherapy in N+, controls 45% of stage IV laryngeal carcinoma. Regional recurrencies are the main cause of failure, more frequent in N+ patientes, present in the first 36 months after treatment.     

Function preservation in stage III squamous laryngeal carcinoma: Results with an induction chemotherapy protocol

Until recently, standard treatment for stage III laryngeal carcinoma (LC) was total laryngectomy and radiotherapy. Recent data suggest that induction chemotherapy (ICH) plays a role in preserving function in advanced head and neck cancer. No reports to date prospectively evaluate ICH exclusively in stage III LC. The authors designed a sequential phase II trial to assess if ICH allowed a conservative treatment in this disease. The objective of the first part of the study was to rule out a complete response rate with ICH below 30% with P≤.05. ICH protocol consisted of three courses of cisplatin 100 mg/M₂ on day 1 and 5-fluorouracil 5000 mg/M₂ continuous infusion over 120 hours. Radiotherapy was administered to patients who attained a complete response (CR). Functional surgery (FS) was planned for patients with partial response. A total laryngectomy followed by radiotherapy was performed when FS was not feasible. Fifty-two previously untreated patients (all males) with squamous stage III LC were diagnosed in our institution, and 46 were entered in the ICH trial. After 9 patients were included, data showed 7 (78%) CR, ruling out a CR rate of less than 30%. After ICH, a CR was achieved in 29 (63%) of 46 patients. At the end of treatment, 35 patients (76%) had a functioning larynx. With a median follow-up of 3 years, larynx function was preserved in 26 (57%) of 46 patients and in 64% of survivors. Four-year actuarial larynx function preservation, overall survival, and disease-free survival were 55%, 77%, and 67%, respectively. Karnofsky performance score over 80% was the only significant prognostic factor in overall survival (94% at 4 years) and disease-free survival (78% at 4 years). In conclusion, the authors believe that ICH followed by response-related second treatment is safe and effective in preserving laryngeal function in stage in LC. There is no evidence of worsening survival.     

Does Induction Chemotherapy Still Have a Role in Larynx Preservation Strategies? The Experience of Institut Catala d'Oncologia in Stage III Larynx Carcinoma

BACKGROUND: Radiotherapy with concurrent cisplatin is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of induction chemotherapy in larynx-preservation therapies remains unknown. Hyperfractionation radiotherapy might improve disease-free survival. METHODS: From August 1993 to August 2004, 71 patients with T3N0-1 larynx tumors and eligible for total laryngectomy received induction chemotherapy with three cycles of cisplatin plus fluorouracil. Clinical tumor response was assessed by indirect laryngoscopy and computed tomography scan. Patients with complete response received hyperfractionation radiotherapy, whereas those without complete response were proposed for total laryngectomy. RESULTS: A total of 71 consecutive patients were included. Thirty-three patients achieved complete response to induction chemotherapy (46.5%), four of them presented a tumor relapse, and all underwent salvage surgery. Seventy-six percent of surviving patients preserved a functional larynx. Despite not achieving complete response, 15 patients refused total laryngectomy and received hyperfractionation radiotherapy. Seven patients presented a tumor relapse and salvage surgery was performed in three of them. Fifty percent of surviving patients preserved a functional larynx. Twenty-two patients without complete response underwent total laryngectomy; three of them presented a tumor relapse but none could be rescued. With a median follow up of 68 months, 5 five-year overall survival, 5-year disease-free survival, and 5-year larynx function preservation survival rates were 68% (confidence interval [CI], 57-80), 75% (CI, 64-87), and 42% (CI, 29-54), respectively. No differences in overall survival were observed between groups. Five-year disease-free survival of patients without complete response who received hyperfractionation radiotherapy was significantly lower than that of the other two groups (P < .02). Ten patients with larynx preservation and no tumor relapse had chronic toxicity that caused the loss of larynx function: seven patients required permanent tracheotomy, two died from pneumonia, and one patient died as a result of a laryngeal necrosis. CONCLUSIONS: Patients with complete response to induction chemotherapy in laryngeal carcinoma have a high probability of cure after hyperfractionation radiotherapy. However, hyperfractionation radiotherapy induces a high degree of toxicity that reduces the laryngeal function preservation rate and may jeopardize overall survival.     

梨状窝癌手术前后放疗与喉功能保全

目的探讨梨状窝鳞状细胞癌(简称梨状窝癌)手术前或手术后放疗与喉功能保全治疗的效果。方法回顾性分析1985年9月—2001年7月收治的梨状窝鳞状细胞癌134例。术前放射治疗+手术治疗(简称R+S)100例,手术+术后放疗(简称S+R)34例。随访中位时间38.1个月。结果根据KaplanMeier方法统计R+S组与S+R组3年生存率分别为54.8%、50.1%,5年生存率分别为51.1%、45.9%,差异均无统计学意义(P>0.05)。T1、T2、T3和T4期患者在R+S组与S+R组喉功能保留情况分别为4/5、3/3,66.7%(32/48)、6/6,32.4%(12/37)、0(0/16)和0(0/10)、0/9,其中T3期喉功能保留率R+S组较高,与S+R组的差异有统计学意义(P<0.05),其喉功能保留与丧失在局部复发、生存率等相关因素差异无统计学意义。R+S组和S+R组术后大体标本切缘阳性率为7.0%(7/100)和20.6%(7/34),两者差异有统计学意义(P<0.05)。Cox多因素变量分析切缘阳性、临床N分期对预后呈明显相关(P值均<0.05)。结论计划性术前放疗与术后放疗在下咽梨状窝癌的治疗上具有相同疗效。声门旁间隙受侵的T3病例选择R+S治疗可以提高喉功能的保留率,不增加预后的风险。R+S治疗方式切缘阳性率低,对喉功能的保留提供可靠客观依据。临床N分期对预后影响很大,是综合治疗的难点。     

Effectiveness of salvage neck dissection for advanced regional metastases when induction chemotherapy and radiation are used for organ preservation.

The recently completed VA Cooperative Study (CSP #268) of induction chemotherapy (cisplatin/5-FU) and definitive radiation (6600 to 7600 cGy) for organ preservation in advanced (stage III or IV) laryngeal cancer demonstrated that, although larynx preservation could be achieved in 64% of randomized preservation could be achieved in 64% of randomized patients, overall survival rates were not improved over conventional treatment (surgery/postoperative radiation). Of 166 patients randomized to induction chemotherapy, 46 had N2 or N3 disease and were analyzed to determine the effectiveness of the organ preservation treatment strategy on control of neck disease and survival. The clinical response of neck metastases to induction chemotherapy was significantly associated with subsequent salvage neck dissection (P = .008). The overall death rate was increased (P = .014) and survival time decreased in patients with less than a complete response in the neck after chemotherapy (P = .15). This was related primarily to failure to control the disease in the neck. The overall survival of patients achieving a complete response in the neck was improved over the randomized group of N2 or N3 patients treated with primary surgery. The findings suggest that response of neck nodes should be assessed independently of primary tumor response in trials of organ preservation strategies using induction chemotherapy, and that failure to achieve a clinical complete response in the neck warrants planned early salvage neck dissection in order to achieve improved overall survival.     

Resultados de un protocolo de preservación de órgano en pacientes con tumores localmente avanzados de la laringe

Introduction and objectivesAdvanced laryngeal carcinoma patients, candidates for total laryngectomy, nowadays have different treatment options. One of them is induction chemotherapy, which allows modulation of the second manoeuvre according to the degree of response achieved. This study presents the results of a large series of patients treated according to this protocol.MethodsRetrospective study of 370 patients with T3-T4 carcinomas of the larynx considered as candidates for total laryngectomy. All patients were treated with the protocol mentioned above.ResultsSeven patients died as a consequence of the treatment with chemotherapy. Among 363 patients finishing chemotherapy, 154 (43 %) achieved complete response and proceeded with radiotherapy. Total laryngectomy was performed in 135 (37 %) non-responders and 74 (20 %) patients were treated with radiotherapy in spite of an incomplete response to chemotherapy. Overall actuarial survival was 73 % at five years. Survival for patients with complete response and treated with radiotherapy was 77 % and for non-responders subjected to total laryngectomy it was 76 %. Non-responders treated with radiotherapy had a 5-year survival rate of 64 %, significantly different to both other groups (p = 0.01). Larynx preservation was achieved in 42 % of the patients, rising to 72 % for complete responders to chemotherapy and to 62 % in non-responders receiving radiotherapy.ConclusionsOur larynx preservation protocol including induction chemotherapy for patients with advanced carcinomas who are candidates for total laryngectomy achieved a total survival rate of 73 % with a 42 % larynx preservation rate. The response to the induction chemotherapy was the factor contributing most to larynx preservation.     

Expression of Bcl-2 family proteins in advanced laryngeal squamous cell carcinoma: correlation with response to chemotherapy and organ preservation

OBJECTIVES/HYPOTHESIS: Induction chemotherapy and definitive radiation therapy in advanced laryngeal cancer has been shown to achieve survival rates that are similar to total laryngectomy and postoperative radiation therapy. In patients with advanced laryngeal cancer, quality of life can be significantly enhanced by treatment regimens that preserve the larynx. However, which patients will respond best to organ preservation protocols remains unknown. The Bcl-2 family proteins are involved in control of apoptosis and, potentially, tumor response to chemotherapy. STUDY DESIGN: Retrospective analysis of immunohistochemical tumor characteristics and clinical outcome. METHODS: To determine whether Bcl-2 family proteins were predictive of successful organ preservation, immunohistochemical analysis of tissue specimens from 47 patients with advanced laryngeal cancer from the U.S. Department of Veterans Affairs Cooperative Study Program (VA CSP-268) were evaluated for the expression of Bcl-2, Bcl-X(L), and Bax protein expression. Tumor response was classified as either complete or partial/nonresponse after induction chemotherapy. Protein expression was correlated with tumor response, organ preservation, and overall patient survival. RESULTS: The Bcl-2 protein was expressed at high levels in only 15% of specimens, but five of seven tumors with high Bcl-2 showed complete response (P = .10). The majority of tumors expressed high levels of Bcl-X(L) (74%). Reduced expression of Bcl-X(L) was associated with a complete response (P = .143) and with larynx preservation (P = .06). Most patients (81%) had increased levels of Bax expression. Reduced expression of Bax was associated with a complete response rate (P = .074), but there was no correlation between Bax expression and larynx preservation. CONCLUSIONS: The findings indicate that laryngeal cancer cells typically produce high levels of only one of the apoptosis protective proteins, Bcl-2 or Bcl-X(L). Prospective studies of larger numbers of patients are under way to determine whether Bcl-X(L) expression will be a useful marker predicting larynx preservation.     

Concurrent chemoradiotherapy for T4 patients with hypopharyngeal and laryngeal squamous cell carcinomas

OBJECTIVES: Concurrent chemoradiotherapy (CCR) was given for the previously untreated T4 hypopharyngeal and laryngeal squamous cell carcinoma patients and the response and survival rates were evaluated. PATIENTS AND METHODS: A total of 23 patients, namely, 15 for hypopharynx and 8 for larynx were eligible. These patients were given cisplatin and 5-fluorouracil based chemotherapeutic regimens with conventional radiotherapy for a total dose of 66.6-70.2 Gy. RESULTS: Ten out of the 15 hypopharyngeal carcinoma patients and 4 out of the 8 laryngeal carcinoma patients showed a complete response at the primary sites. The 5-year disease-specific survival rate was 59.4% in all the patients, 51.9% in the hypopharyngeal carcinoma patients, and 71.0% in the laryngeal patients. Seven out of the 12 resectable hypopharyngeal carcinoma patients and 4 out of 8 laryngeal carcinoma patients were able to do without total laryngectomy. CONCLUSIONS: Based on these results, the survival rate in the hypopharyngeal and laryngeal T4 carcinoma patients treated by CCR seems to be satisfactory and the possibility of organ preservation for the advanced patients is indicated.     

1115例喉癌患者的生存分析

目的 了解20世纪80～90年代外科治疗喉癌的远期效果，并且探讨影响预后的因素。方法 应用回顾性调查的方法，对1983～1996年间中国医科大学第一附属医院耳鼻咽喉科1115例喉癌患者进行分析，统计患者的生存率和死亡原因。结果 生存5年以上者780例，死亡260例，失访75例，累积生存率曲线统计5年生存率为77％，其中Ⅰ期为94％、Ⅱ期为89％、Ⅲ期为82％、Ⅳ期为66％。不同分型的5年生存率由高到低的顺序是声门型、声门上型、声门下型、跨声门型。喉部分切除术患者的5年生存率为85％，而喉全切除术患者的5年生存率为68％。患者5年内死亡的主要原因是局部复发和转移(70％)，另有14％的死亡者没有弄清他们的死亡原因。结论 近20年我国喉癌治疗水平得到明显提高，早期诊断是提高喉功能保留手术比例和提高生存率的关键，患者5年内死亡的原因主要是局部复发和转移。     

晚期喉癌的综合治疗分析

目的　评价综合治疗在晚期喉癌中的应用价值。方法　回顾性分析 1984～ 1997年河北医科大学第四医院耳鼻咽喉科 2 0 4例晚期喉癌 (不包括远处转移病例 )经单纯手术、手术 放射治疗、手术 放射治疗 化学治疗等不同方法治疗的疗效。结果　总的 3、5年的生存率分别是 70 1%(14 3/2 0 4 )和 6 1 8% (12 6 /2 0 4 )。其中 ,综合治疗组 5年生存率为 6 8 2 % (90 /132 ) ,单纯手术组 5年生存率为 5 0 0 % (36 /72 ) ,差异有显著性意义 (χ2 =3 2 6 ,P <0 0 5 )。单纯手术组的复发率为 2 7 8% ,综合治疗组为 2 2 7% ,二者之间差异无显著性意义 (χ2 =0 6 5 ,P >0 0 5 )。综合治疗组远处转移率为10 6 % ,单纯手术组为 2 0 8% (χ2 =3 99,P <0 0 5 ) ,二者之间差异有显著性意义。术前放射治疗组伤口感染及咽瘘分别为 15 6 % (10 /6 4 )和 18 8% (6 /32 ) ,术前未放射治疗者伤口感染及咽瘘分别为15 7% (2 2 /14 0 )和 14 1% (10 /71) ,二者差异均无显著性意义 (χ2 =0 0 0 33,P >0 0 5 ;χ2 =0 37,P >0 0 5 )。结论　对晚期喉癌采用综合治疗的方法比单纯手术疗效好 ;术前放射治疗不增加术后感染和咽瘘的发生。     

Role of definitive radiation therapy for larynx preservation in patients with advanced laryngeal cancer

OBJECTIVE: Recently, neoadjuvant chemotherapy (CT) and radiation therapy (RT) have been advocated as a standard treatment for laryngeal preservation in patients with locally advanced laryngeal cancer. However, it is still being debated whether adding neoadjuvant CT to conventional RT makes an effective contribution to laryngeal preservation. The current study was designed to resolve this controversy. DESIGN: Retrospective clinical study. SETTING: The Severance Hospital, Yonsei Cancer Center, Yonsei University, Seoul, Korea. METHOD: Eighty patients (stages III, IV) with squamous cell carcinoma of the larynx were divided into two groups according to treatment modalities, which consisted of RT alone (N = 40, Group 1) and neoadjuvant CT plus RT (N = 40, Group 2). Comparative analysis was undertaken to investigate the differences in the organ preservation rate and treatment results between the two groups. RESULTS: There was no significant difference in the response rate and patterns of treatment failure between the two groups. The 5-year survival rate was similar between Group 1 (24%) and Group 2 (31%) (p = .1556). In addition, the larynx was almost equally preserved in Group 1 (62%) versus Group 2 (63%). CONCLUSIONS: Radiation therapy without neoadjuvant CT seems to be a valid alternative treatment for the purpose of laryngeal preservation in locally advanced laryngeal cancer.