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