Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer. (8th July 2022)

• Record Type: Journal Article
• Authors: Eita, Amgad; Mohamed, Nader; Rybkin, Alisa; Kang, Jung Julie; Fiasconaro, Megan; Zhigang, Zhang; Zakeri, Kaveh; Yu, Yao; Sadaka, Emad; Sherman, Eric; Dunn, Lara; Cracchiolo, Jennifer; Wong, Richard J.; Cohen, Marc; Lee, Nancy Y.
• Is Part Of: Laryngoscope. Volume 133:Number 5(2023)
• Page Start: 1138
• Page End: 1145
• Publication Date: 2022-07-08
• Subjects: chemotherapy -- hypopharyngeal cancer -- laryngeal cancer -- radiation therapy; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.30279
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objective: Limited data is available to guide non‐surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long‐term therapeutic and functional outcomes. Methods: We reviewed the nonoperative management of T4 laryngeal ( n = 44) and hypopharyngeal ( n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). Results: The 2‐/5‐year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non‐intensity‐modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease‐free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow‐up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion: We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. Level of Evidence: 4 Laryngoscope, 133:1138–1145, 2023 Abstract : Limited data exists on the non‐surgical management of stage T4 larynx and hypopharynx cancer patients who are not surgical candidates or refuse surgery. This study aims to investigate the clinical and functional outcomes of non‐surgical management of T4 larynx and hypopharynx cancer patients. The outcomes reported in this study will provide guidance for those who have unresectable disease or refuse surgery for advanced laryngeal and hypopharyngeal cancer patients.