PMID- 15280724
OWN - NLM
STAT- MEDLINE
DCOM- 20040831
LR  - 20061115
IS  - 0023-852X (Print)
IS  - 0023-852X (Linking)
VI  - 114
IP  - 8
DP  - 2004 Aug
TI  - Management of stage IV glottic carcinoma: therapeutic outcomes.
PG  - 1438-46
AB  - OBJECTIVES/HYPOTHESIS: The best therapeutic approach for the treatment of stage 
      IV glottic carcinoma is controversial. STUDY DESIGN: A retrospective study. 
      METHODS: A retrospective study of Tumor Research Project data was performed using 
      patients with stage IV glottic squamous cell carcinoma treated with curative 
      intent by five different treatment modalities from 1955 to 1998 at Washington 
      University School of Medicine and Barnes-Jewish Hospital (St. Louis, MO). 
      RESULTS: Ninety-six patients with stage IV glottic carcinoma were treated by five 
      modalities: total laryngectomy (TL) (n = 13), total laryngectomy with neck 
      dissection (TL/ND) (n = 18), radiation therapy alone (RT) (n = 7) (median dose, 
      69.5 Gy), total laryngectomy combined with radiation therapy (TL/RT) (n = 10), 
      and total laryngectomy and neck dissection combined with radiation therapy 
      (TL/ND/RT) (n = 48). The overall 5-year observed survival (OS) rate was 39%, and 
      the 5-year disease-specific survival (DSS) rate was 45%. The 5-year DSS rates for 
      the individual treatment modalities included the following: TL, 58.3%; TL/ND, 
      42.9%; RT, 50.0%; TL/RT, 30.0%; and TL/ND/RT, 43.9%. There was no significant 
      difference in DSS for any individual treatment modality (P =.759). The overall 
      locoregional control rate was 69% (66 of 96). The overall recurrence rate was 39% 
      with recurrence at the primary site and in the neck at 19% and 17%, respectively. 
      Recurrence was not related to treatment modality. The 5-year DSS after treatment 
      of locally recurrent cancer (salvage rate) was 30% (3 of 10) and for recurrent 
      neck disease (28 of 67) was 42%. The incidence of delayed regional metastases was 
      28%; of distant metastasis, 12%; and of second primary cancers, 9%. There was no 
      statistically significant difference in survival between node-negative (N0) necks 
      initially treated (5-y DSS, 31%) versus N0 necks observed and later treated if 
      necessary (5-y DSS, 44%) (P =.685). CONCLUSION: The five treatment modalities had 
      statistically similar survival, recurrence, and complication rates. The overall 
      5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 
      39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean 
      survival of 10.1 years and a median survival of 3.9 years. Patients younger than 
      age 55 years had better survival (DSS) than patients 56 years of age or older (P 
      =.0002). Patients with early T stage had better survival than patients with more 
      advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in 
      the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on 
      survival. Tumor recurrence was not related to treatment modality. Patients with 
      clear margins of resection had a statistically significant improved survival (DSS 
      and CDSS) compared with patients with close or involved margins (P =.0001). 
      Post-treatment quality of life was not significantly related to treatment 
      modality. Patients whose N0 neck was treated with observation and appropriate 
      treatment for subsequent neck disease had statistically similar survival compared 
      with patients whose N0 neck was treated prophylactically at the time of treatment 
      of the primary. A minimum of 7 years of follow-up is recommended for early 
      identification of recurrent disease, second primary tumors, and distant 
      metastasis. None of the standard treatment modalities currently employed has a 
      statistical advantage regarding survival, recurrence, complications, or quality 
      of life.
FAU - Spector, Gershon J
AU  - Spector GJ
AD  - Department of Otolaryngology--Head and Neck Surgery, Washington University School 
      of Medicine, St. Louis, MO 63110, USA.
FAU - Sessions, Donald G
AU  - Sessions DG
FAU - Lenox, Jason
AU  - Lenox J
FAU - Newland, Donald
AU  - Newland D
FAU - Simpson, Joseph
AU  - Simpson J
FAU - Haughey, Bruce H
AU  - Haughey BH
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Carcinoma, Squamous Cell/mortality/radiotherapy/secondary/*therapy
MH  - Combined Modality Therapy
MH  - Female
MH  - *Glottis
MH  - Humans
MH  - Laryngeal Neoplasms/mortality/pathology/radiotherapy/*therapy
MH  - Laryngectomy
MH  - Male
MH  - Middle Aged
MH  - Neck Dissection
MH  - Neoplasm Recurrence, Local
MH  - Quality of Life
MH  - Salvage Therapy
MH  - Survival Rate
EDAT- 2004/07/29 05:00
MHDA- 2004/09/01 05:00
CRDT- 2004/07/29 05:00
PHST- 2004/07/29 05:00 [pubmed]
PHST- 2004/09/01 05:00 [medline]
PHST- 2004/07/29 05:00 [entrez]
AID - 00005537-200408000-00024 [pii]
AID - 10.1097/00005537-200408000-00024 [doi]
PST - ppublish
SO  - Laryngoscope. 2004 Aug;114(8):1438-46. doi: 10.1097/00005537-200408000-00024.