Changes in Survival in Locally Advanced Laryngeal Carcinoma Over Past Three Decades

Objective: To evaluate the treatment outcome in patients with advanced laryngeal carcinoma treated in the Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine (NEMROCK), from 2005 to 2008. Patients and Methods: We retrospectively reviewed records of 42 patients who had been diagnosed with advanced laryngeal carcinoma and presented to NEMROCK from January 2005 to December 2008. Inclusion criteria were stage III and stage IV laryngeal carcinoma and histopathological diagnosis of squamous cell carcinoma. Primary surgical treatment was total laryngectomy with or without unilateral or bilateral neck dissection. Positive surgical margins, vascular invasion and extra-capsular nodal extension were considered as high-risk features. Radiation therapy represented the adjuvant therapy following surgery. Radiation treatment consisted of external beam radiotherapy (EBRT) twodimensional technique. Post-operative concurrent chemo-radiotherapy (CCRT) was given when indicated. Loco-regional control (LRC) rate, isolated local relapse nodal, locoregional recurrences and distant metastases were all reported. Patients, response to systemic chemotherapy together with its side effects were also reported. Reports of computed tomography (CT) scans before and after treatment were compared. Results: Surgery was the primary treatment modality in 35 (83. 3%) out of 42 patients. Total laryngectomy with unilateral or bilateral neck dissection was made in 32 patients (91. 4%) and without neck dissection was performed in 3 patients (8.6%). Radiation treatment representing the adjuvant therapy following surgery was applied to all 35 patients. Post-operative CCRT was given for 33 (94.3%) out of 35 patients. The incidence of laryngeal cancer was 3 % in this period. The median overall survival (OAS) for patients in the surgical group was 22 months (range, 6-52 months). The (OAS) rate in the surgical group of patients was 78% at 2 years, 58% at 4 years. While the median disease free survival (DFS) was 18 months (range: 4-52 months) and 75% and55% at 2 and 4 years respectively. During the follow-up period, among the 35 patients, the loco-regional control rate was 80.1% and the median overall survival (OAS) for relapsing patients was 13 months. The toxicities were all tolerable and no fatal case was recorded. Conclusion: Total laryngectomy and ipsilateral or bilateral neck dissection followed by postoperative radiotherapy should be considered as a recommendable treatment approach in patients with resectable advanced laryngeal cancer. We strongly advocate the acceptance of postoperative concurrent chemon-radiotherapy in cases with surgical specimen demonstrating high risk pathological features.