T4 larinks kanseri için tedavi seçimi: kemoradyoterapi ile organ koruyucu yaklaşım mümkün mü yoksa multimodalite tedavi daha mı etkili?

Abstract

Amaç: Organ koruyucu yaklaşım, ileri evrede larinks kanseri (LK) için benzer sağkalım sonuçları ile kanıta dayalı bir tedavi seçeneği olarak önerilmektedir. Ancak T4 hastalıkta organ koruma yaklaşımı tartışmalıdır ve öncelikle cerrahi tedavi tercih edilmektedir. Bu çalışmanın amacı, kemoradyoterapi (KRT) ve postoperatif radyoterapi (RT)/KRT uygulanan T4 LK'li hastalarda tedavi sonuçlarını değerlendirmektir. Gereç ve Yöntem: 2015 ve 2021 yılları arasında KRT (19 hasta) ve adjuvan RT/KRT (27 hasta) ile tedavi edilen T4 LK hastalarının retrospektif incelemesi yapılmıştır. Gruplar arasında genel sağkalım (GS), lokal bölgesel rekürrenssiz sağkalım (LBRS) ve hastalıksız sağkalım (HS) karşılaştırıldı. KRT grubu için organ koruma oranı belirlendi. Bulgular: Tüm kohort için medyan takip süresi 39,5 aydı; 5 yıllık GS, LBRS, HS sırasıyla %52,5, %48,1 ve %48,1 idi. 5 yıllık GS, LBRS ve HS oranları açısından tedavi grupları arasında istatistiksel olarak anlamlı fark bulundu ve KRT grubunda sağkalımın azaldığı saptandı (%31,6 vs %67,6, p=0,004; %19,7 vs %72,3, p=0,001; %19,7 vs %72,9, p=0,001). Diğer klinikopatolojik faktörler açısından; çok değişkenli analizde yaş sadece GS üzerinde anlamlıydı, tümör boyutu, nodal evre ve ECE (ameliyat edilen hastalarda) GS, LBRS ve HS oranları ile bağlantılıydı. KRT grubunda 3 yıllık organ koruma oranı %81,5 idi. Sonuç: Cerrahi kolu, KRT grubuna kıyasla GS, LBRS, HS açısından istatistiksel olarak anlamlı derecede üstün sonuçlara sahipti. Bununla birlikte, KRT kolunda büyük ölçüde laringeal koruma gözlendi.

Keywords

• Larinks kanseri
• İleri evre
• Organ koruma
• Radyoterapi
• Larenjektomi
• Sonuç

Treatment selection for T4 laryngeal cancer: is organ-preserving approach possible with chemoradiotherapy or is multimodality treatment more effective?

Abstract

Aims: Organ-preserving approach is recommended as an evidence-based treatment option for advanced laryngeal cancer (LC) with similar survival results. However, the organ-preserving approach in T4 disease is controversial, and surgical treatment is primarily preferred. Today, chemoradiotherapy (CRT) is applied to T4 LC patients who are inoperable for medical or surgical reasons and upon the request of the patient who refuses the recommended surgical treatment. The aim of this study was to evaluate the treatment outcomes in patients with T4 LC who underwent CRT for these conditions and received adjuvant radiotherapy (RT)/CRT as the standard treatment regimen after surgery. Methods: A retrospective review of T4 LC patients treated with CRT (17 patients) and adjuvant RT/CRT (26 patients) between 2015 and 2021 was conducted. Overall survival (OS), local regional recurrence-free survival (LRRFS), and disease-free survival (DFS) were compared between the groups. The organ preservation rate was determined for the CRT group. Results: The median follow-up time for the entire cohort was 41 months, the 5-y OS, LRRFS, and DFS were 55.9%, 51.4%, and 51.9%, respectively. Statistically significant difference was found between the treatment groups in terms of 5-y OS, LRRFS, and DFS rates, and survival was found to be decreased in the CRT group (35.3% vs. 70.2%, p=0.007; 22.1% vs. 75.1%, p= 0.001; 22.1% vs. 75.7%, p=0.001). With respect to other clinicopathological factors, age was the only significant factor in on OS in multivariate analysis, whereas tumor size, nodal stage, and ECE (in the postoperative RT group, except LRRFS) were linked with OS, LRRFS, and DFS rates. Among the patients who underwent CRT, OS was found to be better in the group applied due to the patient’s request compared to the patients referred for RT due to medical or surgical inoperability, and in multivariate analysis, the indication for RT remained an independent predictor of OS. In addition, the 3-y organ preservation rate was 81.5% in the CRT group. Conclusion: The surgical arm had statistically significantly superior results in terms of OS, LRRFS, DFS compared to the CRT group. However, it is also noteworthy that OS was better in cases where RT is applied at the patient’s request without inoperable disease. In addition, laryngeal protection was observed to a large extent in the CRT arm.

Keywords

• Laryngeal cancer
• advanced stage
• organ preservation
• radiotherapy
• laryngectomy
• treatment outcome

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