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

Year 2013, Volume: 3 Issue: 2, 69 - 76, 01.06.2013

Birsen Yücel Ayfer Ay Eren Eda Erdiş Nalan Akgül Babacan Emine Elif Altuntaş

https://doi.org/10.2399/jmu.2013002005

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

References

  • 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.
  • Altekruse S, Kosary C, Krapcho M, et al. SEER cancer statistics review 1975-2007. Bethesda, MD: National Cancer Institute; 2010.
  • Rosai J. Larynx and trachea. In: Rosai J, editor. Ackerman’s surgi- cal pathology. St. Louis: Mosby; 1996. p. 314-32.
  • 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.
  • Dirix P, Lambrecht M, Nuysts S. Radiotherapy for laryngeal squamous cell carcinoma: Current standards. Expert Rev Anticancer Ther 2010;10:1461-9.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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
  • Hao SP, Myers EN. T3 Glottic carsinoma revisited, transglottic vs pure glottic carsinoma. Arch Otolarynıgol 1995;121:166-70.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
  • NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
  • tion in any medium, provided the original work is properly cited.
  • 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
  • survival in patients with larynx cancer. J Med Updates 2013;3(2):69-76.

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

Year 2013, Volume: 3 Issue: 2, 69 - 76, 01.06.2013

Birsen Yücel Ayfer Ay Eren Eda Erdiş Nalan Akgül Babacan Emine Elif Altuntaş

https://doi.org/10.2399/jmu.2013002005

Abstract

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

Keywords

Larinks kanseri sağkalım prognoz yan etki

References

  • 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.
  • Altekruse S, Kosary C, Krapcho M, et al. SEER cancer statistics review 1975-2007. Bethesda, MD: National Cancer Institute; 2010.
  • Rosai J. Larynx and trachea. In: Rosai J, editor. Ackerman’s surgi- cal pathology. St. Louis: Mosby; 1996. p. 314-32.
  • 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.
  • Dirix P, Lambrecht M, Nuysts S. Radiotherapy for laryngeal squamous cell carcinoma: Current standards. Expert Rev Anticancer Ther 2010;10:1461-9.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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
  • Hao SP, Myers EN. T3 Glottic carsinoma revisited, transglottic vs pure glottic carsinoma. Arch Otolarynıgol 1995;121:166-70.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
  • NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
  • tion in any medium, provided the original work is properly cited.
  • 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
  • survival in patients with larynx cancer. J Med Updates 2013;3(2):69-76.
There are 46 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Birsen Yücel This is me

Ayfer Ay Eren This is me

Eda Erdiş This is me

Nalan Akgül Babacan This is me

Emine Elif Altuntaş This is me

Publication Date June 1, 2013
Published in Issue Year 2013 Volume: 3 Issue: 2

Cite

APA Yücel, B., Eren, A. A., Erdiş, E., Babacan, N. A., et al. (2013). Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler. Journal of Medical Updates, 3(2), 69-76. https://doi.org/10.2399/jmu.2013002005
AMA Yücel B, Eren AA, Erdiş E, Babacan NA, Altuntaş EE. Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler. Journal of Medical Updates. June 2013;3(2):69-76. doi:10.2399/jmu.2013002005
Chicago Yücel, Birsen, Ayfer Ay Eren, Eda Erdiş, Nalan Akgül Babacan, and Emine Elif Altuntaş. “Larinks Kanserli hastaların Tedavi sonuçları, Yan Etkileri Ve sağkalımını Etkileyen Prognostik faktörler”. Journal of Medical Updates 3, no. 2 (June 2013): 69-76. https://doi.org/10.2399/jmu.2013002005.
EndNote Yücel B, Eren AA, Erdiş E, Babacan NA, Altuntaş EE (June 1, 2013) Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler. Journal of Medical Updates 3 2 69–76.
IEEE B. Yücel, A. A. Eren, E. Erdiş, N. A. Babacan, and E. E. Altuntaş, “Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler”, Journal of Medical Updates, vol. 3, no. 2, pp. 69–76, 2013, doi: 10.2399/jmu.2013002005.
ISNAD Yücel, Birsen et al. “Larinks Kanserli hastaların Tedavi sonuçları, Yan Etkileri Ve sağkalımını Etkileyen Prognostik faktörler”. Journal of Medical Updates 3/2 (June 2013), 69-76. https://doi.org/10.2399/jmu.2013002005.
JAMA Yücel B, Eren AA, Erdiş E, Babacan NA, Altuntaş EE. Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler. Journal of Medical Updates. 2013;3:69–76.
MLA Yücel, Birsen et al. “Larinks Kanserli hastaların Tedavi sonuçları, Yan Etkileri Ve sağkalımını Etkileyen Prognostik faktörler”. Journal of Medical Updates, vol. 3, no. 2, 2013, pp. 69-76, doi:10.2399/jmu.2013002005.
Vancouver Yücel B, Eren AA, Erdiş E, Babacan NA, Altuntaş EE. Larinks kanserli hastaların tedavi sonuçları, yan etkileri ve sağkalımını etkileyen prognostik faktörler. Journal of Medical Updates. 2013;3(2):69-76.