Treatment results and prognostic factors of advanced T3–4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience

Nguyen-Tan, Phuc F; Le, Quynh-Thu; Quivey, Jeanne-Marie; Singer, Mark; Terris, David J; Goffinet, Don R; Fu, Karen K

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Volume 50, Issue 5 , Pages 1172-1180, 1 August 2001

Treatment results and prognostic factors of advanced T3–4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience

Presented at the Annual Meeting of the Radiological Society of North America (RSNA), Chicago, IL, November 26, 2000.

Phuc F Nguyen-Tan, M.D.C.M.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
- Reprint requests to: Dr. Phuc F. Nguyen-Tan, Department of Radiation Oncology, Hôpital Notre-Dame, 1560 Sherbrooke Street East, Montreal, Quebec, Canada, H2L 4M1
Quynh-Thu Le, M.D.
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
Jeanne-Marie Quivey, M.D.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
Mark Singer, M.D.
- Department of Otolaryngology, University of California, San Francisco, CA, USA
David J Terris, M.D.
- Department of Otolaryngology, Stanford University, Stanford, CA, USA
Don R Goffinet, M.D.
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
Karen K Fu, M.D.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA

Accepted 21 February 2001.

Abstract

To review the UCSF-SUH experience in the treatment of advanced T3–4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival.

We reviewed the records of 223 patients treated for T3–4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28–85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC.

The median follow-up was 41 months (range, 2–367 months) for all patients and 78 months (range, 6–332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT.

Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels ≥ 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.