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Article

Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?

  • Authors:
    • Aleš Čoček
    • Miloslav Ambruš
    • Alena Dohnalová
    • Martin Chovanec
    • Martina Kubecová
    • Kateřina Licková
  • View Affiliations / Copyright

    Affiliations: ENT Department, Oblastní Nemocnice Příbram, 261 01 Příbram, Czech Republic, Radiotherapy and Oncology Clinic, Charles University 3rd Medical School and Royal Vinohrady Teaching Hospital, 100 34 Prague, Czech Republic, Institute of Physiology, Charles University 1st Medical School and General Teaching Hospital, 12800 Prague, Czech Republic, ENT Clinic, Charles University 3rd Medical School and Royal Vinohrady Teaching Hospital, 100 34 Prague, Czech Republic
  • Pages: 6701-6708
    |
    Published online on: March 1, 2018
       https://doi.org/10.3892/ol.2018.8150
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Abstract

Between January 1997 and December 2013, the Charles University 3rd Medical School and Royal Vinohrady Teaching Hospital Ear, Nose and Throat oncology team treated 185 patients with advanced laryngeal cancer, which, from a surgical perspective, required a total laryngectomy. Overall, ~70% of these patients (n=129) underwent conventional treatment (i.e., total laryngectomy with post‑operative radiotherapy), and ~30% (n=56) were treated with larynx preservation protocols (including primary radiotherapy, neoadjuvant chemotherapy followed by radiotherapy or chemoradiotherapy, or primary chemoradiotherapy). Patients treated with laryngeal preservation protocols had a 5‑year survival probability of 48%, whereas those treated with total laryngectomy and post‑operative radiotherapy had a 5‑year survival probability of 63%. This difference was not statistically significant. However, patients who underwent primary surgical treatment survived for a significantly longer period (P<0.010). The sex of the patient did not have a statistically significant impact on patient survival probability. More extensive local disease and more advanced disease stages conferred a lower survival probability, but were not statistically significant; however, a lower survival probability in patients >70 years was identified to be statistically significant (P<0.010). Local disease recurrence and recurrent cervical nodal metastases had a statistically significant impact on the 5‑year survival probability (P<0.001). A step wise Cox regression analysis was used to compare the parameters of sex, patient age, tumor extent, disease stage, choice of primary surgery, local recurrence and cervical nodal recurrence. In the first step, local recurrence was selected as the parameter having the greatest effect on survival (P<0.001); patient age >70 years (P<0.001) was selected in the second step; cervical nodal recurrence (P<0.001) in the third step; and disease stage (P<0.010) in the fourth step. Other parameters did not significantly affect survival. The results of the present study confirmed that primary non‑surgical treatment is an alternative approach to total laryngectomy, and that an informed patient should determine the treatment approach. The decreased overall survival observed in more extensive tumors suggests that surgical treatment may be a better selection in these cases. Due to increased overall survival, primary non‑surgical treatment may be recommended for younger patients. If the patient chooses primary non‑surgical treatment, concomitant chemoradiotherapy is recommended. If the patient cannot tolerate cytostatic chemotherapy, radiotherapy alone is recommended.
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Copy and paste a formatted citation
Spandidos Publications style
Čoček A, Ambruš M, Dohnalová A, Chovanec M, Kubecová M and Licková K: Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?. Oncol Lett 15: 6701-6708, 2018.
APA
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., & Licková, K. (2018). Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?. Oncology Letters, 15, 6701-6708. https://doi.org/10.3892/ol.2018.8150
MLA
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., Licková, K."Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?". Oncology Letters 15.5 (2018): 6701-6708.
Chicago
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., Licková, K."Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?". Oncology Letters 15, no. 5 (2018): 6701-6708. https://doi.org/10.3892/ol.2018.8150
Copy and paste a formatted citation
x
Spandidos Publications style
Čoček A, Ambruš M, Dohnalová A, Chovanec M, Kubecová M and Licková K: Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?. Oncol Lett 15: 6701-6708, 2018.
APA
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., & Licková, K. (2018). Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?. Oncology Letters, 15, 6701-6708. https://doi.org/10.3892/ol.2018.8150
MLA
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., Licková, K."Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?". Oncology Letters 15.5 (2018): 6701-6708.
Chicago
Čoček, A., Ambruš, M., Dohnalová, A., Chovanec, M., Kubecová, M., Licková, K."Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?". Oncology Letters 15, no. 5 (2018): 6701-6708. https://doi.org/10.3892/ol.2018.8150
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