International Journal of Head and Neck Surgery

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VOLUME 1 , ISSUE 3 ( September-December, 2010 ) > List of Articles

RESEARCH ARTICLE

Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer

Arif Jamshed, Raza Hussain, Sarah Jamshed, Aamir Ali Syed, Asif Loya, Mazhar Ali Shah, Uzma Majeed, Shahid Hameed

Citation Information : Jamshed A, Hussain R, Jamshed S, Syed AA, Loya A, Shah MA, Majeed U, Hameed S. Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer. Int J Head Neck Surg 2010; 1 (3):153-160.

DOI: 10.5005/jp-journals-10001-1030

Published Online: 00-12-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Despite the acceptance of concomitant chemoradiation (CRT) as an alternative to total laryngectomy (TL) in locally advanced laryngeal cancer (LALC), laryngeal preservation is sparingly recommended in developing countries. We report on prognostic factors and survival in T3/T4 laryngeal cancer treated with concomitant CRT at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH and RC) to provide comparison with other geographic locations.

Material and Methods

During the period November 2003-April 2009, 101 patients with biopsy proven untreated LALC underwent concurrent CRT treatment at SKMCH and RC. According to AJCC staging system (6th edition) 41 had T3 and 60 patients had T4 disease. Radiation dose to the larynx was 70 Gy in 35 fractions with concomitant cisplatin. Induction chemotherapy was given to 42 patients. Thirty-one patients required tracheotomy either before or during concomitant CRT.

Results

Actuarial overall survival and laryngectomy free survival (LFS) for the whole group at 5 years were 54% (95% CI; 48-60) and 47% (95% CI; 42-52) respectively. Median LFS was 4.17 years. On univariate analysis patients with T4 tumors (p = 0.04), positive neck nodal disease (p = 0.02), supraglottic site (p = 0.02) and tracheotomy (0.009) had a significantly inferior LFS. Multivariate analysis showed tracheotomy to be the only factor significantly (p = 0.03) related to a higher risk of failure for LFS.

Conclusion

Survival rates for LALC treated with concomitant CRT in our institution are acceptable. Our study supports the use of TL in patients with compromised airways that require tracheotomy as outcome with concomitant CRT is poor.


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