Treatment results, side effects and prognostic factors affecting survival in patients with larynx cancer

Abstract

Objective: Our aim was to determine the treatment results, side effects and the prognostic factors affecting survival in patients with larynx cancer treated in our clinic. Methods: Data of a total of 90 patients with larynx carcinoma were included in the study. The patients' performance scores were evaluated according to the Eastern Cooperative Oncology Group (ECOG) system. Results: Eighty-seven (97%) patients were male and three patients (3%) were female. The median age of the patients was 59 (37-86) years. Early-stage, locally advanced stage, and metastatic disease were detected in 43, 55, and 2% of the patients, respectively. Laryngeal cancers were observed in the glottic (53%), and supraglottic (47%) regions. Performance score (p=0.022), grade (p=0.033), lymph node metastasis (p=0.001), T stage (p=0.034) and disease stage (p=0.007) were significantly unfavourable in supraglottic cancers compared to glottic cancers. Recurrence was observed in 17% of the patients in a median 15 (range: 5-96) months. Distant metastasis was observed in 12% of the patients in a median 17 (range: 1-155) months. The factors affecting survival were the presence of comorbidities (p=0.032), performance status (p=0.022), hemoglobin level (p=0.003), T stage (p=0.006), disease stage (p=0.011), and weight loss (p=0.002). When RT- and CRT-associated side effects were compared, the incidence of adverse effects such as mucositis (p

Keywords

• Larynx cancer, survival, prognosis, side effect

Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler

Öz

Amaç: Bu çalışmada, kliniğimizde tedavi edilen larinks kanserli hastaların tedavi sonuçları, tedavilerin yan etkileri ve hastaların sağkalımını etkileyen prognostik faktörlerin belirlenmesi amaçlanmıştır. Yöntem: Çalışmada 90 hasta verisi analiz edilmiştir. Hastaların performans statüsü 2010'da revize edilmiş Doğu Onkoloji İşbirliği Grubu (Eastern Cooperative Oncology Group, ECOG) skorlama sistemine göre değerlendirilmiştir. Bulgular: Hastaların %97'si erkek ve %3'ü kadın olup, medyan yaşı 59 (37-86) idi. Erken evre %43, lokal ileri evre %55, metastatik evre kanser %2 hastada saptandı. Hastaların %53'ünü glottik kanserler, %47'sini supraglottik kanserler oluşturmaktaydı. Supraglottik kanserlerin performans durumu (p=0.022), grade (p=0.033), T evresi (p=0.034), lenf nod metastazı (p=0.001), hastalık evresi (p=0.007) bakımından glottik kanserlere göre daha kötü özelliklere sahip olduğu saptandı. Medyan 15 (dağılım: 5-96) ayda hastaların %17'sinde nüks, medyan 17 (dağılım: 1-155) ayda da hastaların %12'sinde uzak metastaz tespit edildi. Hastaların sağkalımını komorbidite (p=0.032), performans durumu (p=0.022), hemoglobin düzeyi (p=0.003), T evresi (p=0.006), hastalık evresi (p=0.011), kilo kaybı (p=0.002) etkilemekteydi. Kemoradyoterapi uygulanan hastalarda mukozit (p

Anahtar Kelimeler

• Larinks kanseri, sağkalım, prognoz, yan etki

References

1. Higgins KM, Wang JR. State of head and neck surgical oncology research-a review and critical appraisal of landmark studies. Head Neck 2008;30:1636-42.
2. Altekruse S, Kosary C, Krapcho M, et al. SEER cancer statistics review 1975-2007. Bethesda, MD: National Cancer Institute; 2010.
3. Rosai J. Larynx and trachea. In: Rosai J, editor. Ackerman’s surgi- cal pathology. St. Louis: Mosby; 1996. p. 314-32.
4. Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 2006;116:1-13.
5. Dirix P, Lambrecht M, Nuysts S. Radiotherapy for laryngeal squamous cell carcinoma: Current standards. Expert Rev Anticancer Ther 2010;10:1461-9.
6. Tamura Y, Tanaka S, Asato R, et al. Therapeutic outcomes of laryngeal cancer at Kyoto, University Hospital for 10 years. Acta Otolaryngol Suppl 2007;557:62-5.
7. Agudelo D, Quer M, Leon X, Diez S, Burgues J. Laryngeal carci- noma in patients without a history of tobacco and alcohol use. Head Neck 1997;19:200-4.
8. Boffetta P, Merletti F, Faggiano F, et al. Prognostic factors and survival of laryngeal cancer patients from Turin, Italy. A popula- tion-based study. Am J Epidemiol 1997;145:1100-5.

9. Hirvikoski P, Kumpulainen E, Virtaniemi J, et al. p53 expression and cell proliferation as prognostic factors in laryngeal squamous cell carcinoma. J Clin Oncol 1997;15:3111-20.
10. Teppo H, Soini Y, Melkko J, Koıvunen P, Alho OP. Prognostic factors in laryngeal carcinoma: the role of apoptosis, p53, prolifer- ation (Ki-67) and angiogenesis. APMIS 2003;111:451-7.
11. Jin T, Lin HX, Lin H, et al. Expression TGM2 and BNIP3 have prognostic significance in laryngeal cancer patients receiving sur- gery and postoperative radiotherapy: a retrospective study. J Transl Medicine 2012;10:64.
12. Mountzios G, Kostopoulos I, Kotoula V, et al. Insulin-like growth factor 1 receptor (IGF1R) expression and survival in operable squamous-cell laryngeal cancer. PloS One 2013;8(1):e54048.
13. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organisation for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 119;31:1341-6.
14. Şengül E, Ba¤lam T, Çevik C, et al. The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases. [Article in Turkish] Journal of Clinical and Experimental Investigations 2012;3:214-22.
15. Raitiola H, Pukander J, Laippala P. Glottic and supraglottic laryn- geal carcinoma: differences in epidemiology, clinical characteris- tics and prognosis. Acta Otolaryngol 1999;119:847-51
16. Hao SP, Myers EN. T3 Glottic carsinoma revisited, transglottic vs pure glottic carsinoma. Arch Otolarynıgol 1995;121:166-70.
17. Cosselin BJ, Gullane PJ. Cancer of the larynx, paraınasal sinus- es and temporal bone. In: Lee KJ, editor. Essential otolaryngol- ogy head and neck surgery. Sixth ed. Norwaik, CT: Appleton and Lange; 1995. Chapter 29, p. 555-80.
18. Kowalski LP, Franco EL, de Andrade Sobrinho J. Factors influ- encing regional lymph node metastasis from laryngeal carcinoma. Ann Oto Rhino Laryngol 1995;104:442-7.
19. Silvestri F, Bussani R, Stanta G, Cosatti C, Ferlito A. Supraglottic versus glottic laryngeal cancer: epidemiological and pathological aspects. ORL J Otorhinolaryngol Relat Spec 1992;54:43-8.
20. Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 2006;116:1-13.
21. Gourin CG, Conger BT, Porubsky ES, Sheils WC, Bilodeau PA, Coleman TA. The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope 2009;119:1312-7.
22. Berrino F, De Angelis R, Sant M, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007; 8:773-83.
23. Zhang SY, Zhong ML, Luo XN, et al. Retrospective analysis of prognostic factors in 205 patients with larengeal squamous cell carcinoma who underwent surgical treatment. PloS One 2013; 8(4):e60157.
24. Mendenhall WM, Hinerman RW, Amdur RJ, Mancusco AA, Villaret DB, Robbins KT. Larynx. In: Perez CA, Brady LW, Halperin EC, Schmidt-Ullrich RK, editors. Principles and practice of radiation oncology. 4th ed. Philadelphia: Lippincott Williams& Wilkins; 2004. p. 1094-116.
25. Chen MF, Chang JT, Tsang NM, Liao CT, Chen WC. Radiotherapy of early-stage glottic cancer: analysis of factors affecting prognosis. Ann Otol Rhinol Laryngol 2003;112:904-11.
26. Mercante G, Bacciu A, Banchini L, Moretto E, Oretti, Ferri T. Salvage surgery after radiation failure in squamous cell carcinoma of the larynx. B-ENT 2005;1:107-11.
27. Çalo¤lu M, Yürüt Çalo¤lu V, Uzal C, Karagöl H, Tokatlı F, Uygun K. Prognostic factors and treatment results in laryngeal carcinoma: Department of Radiation Oncology of Trakya University Medical School experience. [Article in Turkish] Türk Onkoloji Dergisi 2005;20:20-6.
28. Uruk Ataman Ö, Akman F, Da¤ N, et al. Treatment results of definitive radiotherapy in 144 early stage larynx carcinoma. [Article in Turkish] Türk Onkoloji Dergisi 2006;21:143-50.
29. Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.
30. Cooper JS, Pajak TF, Forastiere AA, et al.; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risksquamous-cell carci- noma of the head and neck. N Engl J Med 2004;350:1937-44.
31. Bernier J, Domenge C, Ozsahin M, et al.; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945-52.
32. Morris LGT, Sikora AG, Patel SG, Hayes RB, Ganly I. Second Primary Cancers After an Index Head and Neck Cancer: Subsite- Specific Trends in the Era of Human Papillomavirus–Associated Oropharyngeal Cancer. J Clin Oncol 2011;29:739-46.
33. Licciardello JT, Spitz MR, Hong WK. Multiple primary cancer in patients with cancer of the head and neck: second cancer of the head and neck, esophagus, and lung. Int J Radiat Oncol Biol Phys 1989;17:467-76.
34. Fujita M, Rudoltz MS, Canady DJ, et al. Second malignant neo- plasia in patients with T1 glottic cancer treated with radiation. Laryngoscope 1998;108:1853-5.
35. McDonald S, Haie C, Rubin P, Nelson D, Divers LD. Second malignant tumors in patients with laryngeal carcinoma: diagnosis, treatment, and prevention. Int J Radiat Oncol Biol Phys 1989;17: 457-65.
36. Holland JM, Arsanjani A, Liem BJ, Hoffelt SC, Cohen JI, Stevens KR Jr. Second malignancies in early stage laryngeal carcinoma patients treated with radiotherapy. J Laryngol Otol 2002;116:190- 3.
37. Liao LJ, Chou HW, Wang CT, Chung CS, Lai MS. The impact of second primary malignancies on head and neck cancer sur- vivors: a nationwide cohort study. PloS One 2013; 8(4):e62116.
38. Mehdiyev H, Gökcan MK, Do¤an M, Demirtafl M. Second pri- mary malignites in 629 patients with laryngeal carcinoma. [Article in Turkish] Cumhuriyet Medical Journal 2010;32:331-3.
39. Esassolak M, Dubova S, Kamer S, Aydın B. Curative radiothera- py in early stage glottic laryngeal carcinoma. [Article in Turkish] Türk Onkoloji Dergisi 2006;21:28-36.
40. Rutkowski T, Wygoda A, Sk∏adowski K, et al. Predictors of radio- therapy outcome in patients with T2 supraglottic carcinoma. Eur Arch Otorhinolaryngol 2012;269:923-9.
41. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845-52.
42. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
43. NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
44. tion in any medium, provided the original work is properly cited.
45. Please cite this article as: Yücel B, Ay Eren A, Erdifl E, Akgül Babacan N, Altuntafl EE. Treatment results, side effects and prognostic factors affecting
46. survival in patients with larynx cancer. J Med Updates 2013;3(2):69-76.