Oncological and Functional Outcomes of Larynx-Preserving Surgery for Hypopharyngeal Cancer: A Comparison with Definitive Radiation-Based Treatment
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Larynx-preserving surgery (LPS) have recently gained popularity and achieved comparable oncologic outcomes to conventional radical surgery for localized hypopharyngeal cancer (HPC). In the current study, the role of LPS has been assessed thoroughly in comparison with upfront radiation therapy (RT). Materials and methods: We retrospectively reviewed 185 candidates for LPS with cT1-2 disease; 59 patients underwent upfront LPS while 126 patients received upfront RT, respectively. Oncological and functional outcomes were investigated and compared. Results: Following LPS, safe margin (≥ 5 mm) was achieved in 37.3% of patients. Overall, better clinical outcomes at 5 years were achieved following upfront LPS than those following upfront RT: overall survival (OS) (72.7% vs. 59.0%, p=0.045), disease-free survival (DFS) (59.8% vs. 45.0%, p=0.039), and functional laryngeal preservation (100% vs. 89.7%, p=0.010). Although similar outcomes were observed in patients with cT1 disease, better 5-year DFS was achieved following upfront LPS in patients with cT2 disease (57.0% vs. 36.4%, p=0.023) by virtue of better local control. Despite frequent cN2-3 disease in upfront LPS group, comparable outcomes were observed between upfront RT and LPS group. However, multivariable analyses revealed that performance status and double primary cancer diagnosed within 6 months of HPC diagnosis affected OS significantly, while treatment modality per se did not. Conclusion: Although upfront LPS could provide better local control than upfront RT in patients with cT2 disease, overall outcomes were comparable following either modality. Treatment selection of larynx-preserving approach for HPC should be individualized based on tumor and patient factors.
Abstract
Purpose: Larynx-preserving surgery (LPS) have recently gained popularity and achieved comparable oncologic outcomes to conventional radical surgery for localized hypopharyngeal cancer (HPC). In the current study, the role of LPS has been assessed thoroughly in comparison with upfront radiation therapy (RT). Materials and methods: We retrospectively reviewed 185 candidates for LPS with cT1-2 disease; 59 patients underwent upfront LPS while 126 patients received upfront RT, respectively. Oncological and functional outcomes were investigated and compared. Results: Following LPS, safe margin (≥ 5 mm) was achieved in 37.3% of patients. Overall, better clinical outcomes at 5 years were achieved following upfront LPS than those following upfront RT: overall survival (OS) (72.7% vs. 59.0%, p=0.045), disease-free survival (DFS) (59.8% vs. 45.0%, p=0.039), and functional laryngeal preservation (100% vs. 89.7%, p=0.010). Although similar outcomes were observed in patients with cT1 disease, better 5-year DFS was achieved following upfront LPS in patients with cT2 disease (57.0% vs. 36.4%, p=0.023) by virtue of better local control. Despite frequent cN2-3 disease in upfront LPS group, comparable outcomes were observed between upfront RT and LPS group. However, multivariable analyses revealed that performance status and double primary cancer diagnosed within 6 months of HPC diagnosis affected OS significantly, while treatment modality per se did not. Conclusion: Although upfront LPS could provide better local control than upfront RT in patients with cT2 disease, overall outcomes were comparable following either modality. Treatment selection of larynx-preserving approach for HPC should be individualized based on tumor and patient factors.
참고문헌 (30)
- Pracy P, "Hypopharyngeal cancer : United Kingdom National Multidisciplinary Guidelines", J Laryngol Otol, 130, pp.S104~S110 (2016)
- Carvalho AL, "Trends in incidence and prognosis for head and neck cancer in the United States : a site-specific analysis of the SEER database", Int J Cancer, 114, pp.806~816 (2005)
- Newman JR, "Survival trends in hypopharyngeal cancer : a population-based review", Laryngoscope, 125, pp.624~629 (2015)
- Chirila M, "Perineural invasion of the major and minor nerves in laryngeal and hypopharyngeal cancer", Otolaryngol Head Neck Surg, 140, pp.65~69 (2009)
- Deleyiannis FW, "Relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer", Ann Otol Rhinol Laryngol, 105, pp.101~108 (1996)
- 김준원, "Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III", IV Hypopharyngeal Cancer, 2016, pp.48(1), 45~53[DOI]
- Dikshit RP, "Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma", Cancer, 103, pp.2326~2333 (2005)
- Clayman GL, "Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers", Arch Otolaryngol Head Neck Surg, 121, pp.219~223 (1995)
- Rades D, "Radiochemotherapy versus surgery plus radio(chemo)therapy for stage T3", T4 larynx and hypopharynx cancer : results of a matched-pair analysis, 2011, pp.47, 2729~2734
- Kim S, "Advanced hypopharyngeal carcinoma treatment results according to treatment modalities", Head Neck, 23, pp.713~717 (2001)
- Habib A, "Management of advanced hypopharyngeal carcinoma : systematic review of survival following surgical and non-surgical treatments", J Laryngol Otol, 132, pp.385~400 (2018)
- Bonner J, "Cetuximab and radiotherapy in laryngeal preservation for cancers of the larynx and hypopharynx : a secondary analysis of a randomized clinical trial", JAMA Otolaryngol Head Neck Surg, 142, pp.842~849 (2016)
- Jang JY, "Comparison of oncological and functional outcomes between initial surgical versus non-surgical treatments for hypopharyngeal cancer", Ann Surg Oncol, 23, pp.2054~2061 (2016)
- Iwae S, "Matched-pair analysis of patients with advanced hypopharyngeal cancer : surgery versus concomitant chemoradiotherapy", Int J Clin Oncol, 22, pp.1001~1008 (2017)
- Vilaseca I, "CO2 laser surgery : a larynx preservation alternative for selected hypopharyngeal carcinomas", Head Neck, 26, pp.953~959 (2004)
- De Virgilio A, "The emerging role of robotic surgery among minimally invasive surgical approaches in the treatment of hypopharyngeal carcinoma : systematic review and meta-analysis", J Clin Med, 8, pp.256~ (2019)
- Joo YH, "Role of larynx-preserving partial hypopharyngectomy with and without postoperative radiotherapy for squamous cell carcinoma of the hypopharynx", Oral Oncol, 48, pp.168~172 (2012)
- 조원경, "Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients", Cancer Research and Treatment, 51(2), pp.603~610 (2019), 대한암학회
- De Bodt MS, "Test-retest study of the GRBAS scale : influence of experience and professional background on perceptual rating of voice quality", J Voice, 11, pp.74~80 (1997)
- Stenson KM, "Swallowing function in patients with head and neck cancer prior to treatment", Arch Otolaryngol Head Neck Surg, 126, pp.371~377 (2000)
- Ho CM, "Submucosal tumor extension in hypopharyngeal cancer", Arch Otolaryngol Head Neck Surg, 123, pp.959~965 (1997)
- Ansarin M, "Laser surgery for early glottic cancer : impact of margin status on local control and organ preservation", Arch Otolaryngol Head Neck Surg, 135, pp.385~390 (2009)
- Steiner W, "Organ preservation by transoral laser microsurgery in piriform sinus carcinoma", Otolaryngol Head Neck Surg, 124, pp.58~67 (2001)
- Martin A, "Organ preserving transoral laser microsurgery for cancer of the hypopharynx", Laryngoscope, 118, pp.398~402 (2008)
- Park YM, "Transoral robotic surgery for hypopharyngeal squamous cell carcinoma : 3-year oncologic and functional analysis", Oral Oncol, 48, pp.560~566 (2012)
- Mazerolle P, "Oncological and functional outcomes of trans-oral robotic surgery for pyriform sinus carcinoma : a French GETTEC group study", Oral Oncol, 86, pp.165~170 (2018)
- Ma DJ, "Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiotherapy in human papillomavirus-associated oropharynx squamous cell carcinoma", J Clin Oncol, 37, pp.1909~1918 (2019)
- Isaacs JH Jr, "Postoperative radiation of open head and neck wounds : updated", Head Neck, 19, pp.194~199 (1997)
- Pelucchi C, "Alcohol and tobacco use, and cancer risk for upper aerodigestive tract and liver", Eur J Cancer Prev, 17, pp.340~344 (2008)
- Paleri V, "Comorbidity in head and neck cancer : a critical appraisal and recommendations for practice", Oral Oncol, 46, pp.712~719 (2010)