ABSTRACT
BACKGROUND: The purpose of this study was to present the outcomes of oropharyngeal cancers treated with intensity-modulated radiotherapy (IMRT) especially the differences between tonsillar and base of tongue (BOT) primaries. METHODS: Retrospective analysis of 124 patients with biopsy proven squamous cell carcinomas of the oropharynx, treated with IMRT. RESULTS: Human papillomavirus (HPV) association correlated with improvement in survivals in both tonsillar and BOT primaries. At the 2-year median follow-up, the cumulative incidences of locoregional recurrences were 8% in both the tonsil and BOT groups (P = .76) but the distant metastases were 8% in the tonsil group versus 26% in the BOT group (P = .009). Thirty percent of tonsil primaries has ≥N2c neck disease as compared to 54% of BOT. Incidence of distant metastases increases with advanced nodal classification, especially >N2c. CONCLUSION: Even though the locoregional controls are excellent with IMRT and chemotherapy, these patients continue to fail distantly, particularly significant for the BOT group and for nodal stage >N2c.
Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Oropharyngeal Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated/statistics & numerical data , Tongue Neoplasms/radiotherapy , Adult , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Disease-Free Survival , Female , Humans , Male , Middle Aged , Oropharyngeal Neoplasms/mortality , Oropharyngeal Neoplasms/pathology , Procedures and Techniques Utilization , Retrospective Studies , Survival Rate , Tongue Neoplasms/mortality , Tongue Neoplasms/pathologyABSTRACT
OBJECTIVE: To evaluate feasibility, functional outcome, and disease control of endoscopic surgery and irradiation in patients with squamous cell carcinoma of the supraglottic larynx. DESIGN: Prospective, single-arm, phase 2 multi-institutional trial. SETTING: Southwest Oncology Group trial S9709. PATIENTS: Thirty-four patients diagnosed as having stage I, stage II, or selected stage III (T1-2N1M0) supraglottic laryngeal carcinoma enrolled from September 15, 1997, to December 1, 2001. INTERVENTIONS: Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy. MAIN OUTCOME MEASURES: Three-year progression-free survival, proportion of patients requiring tracheostomy as a result of surgery, and time to adequate oral intake. RESULTS: All 34 patients underwent surgery without major protocol deviation. Thirty-two patients (94%) completed planned postoperative radiotherapy without major deviation. At the time of analysis, only 1 patient (3%) had documented local disease recurrence at the primary disease site and required salvage total laryngectomy, and 2 patients (6%) had documented regional recurrence and required salvage neck dissection. Estimated 3-year progression-free survival and overall survival were 79% and 88%, respectively. No subjects required tracheostomy as a direct consequence of endoscopic resection. Patients who required tracheostomy before endoscopic resection due to either obstructive tumor bulk or unfavorable anatomy that precluded safe intubation (4 patients [12%]) were all decannulated in the early postoperative period (Subject(s)
Carcinoma, Squamous Cell
, Laryngeal Neoplasms
, Laryngectomy/methods
, Laser Therapy/methods
, Adult
, Aged
, Biopsy
, Carcinoma, Squamous Cell/pathology
, Carcinoma, Squamous Cell/radiotherapy
, Carcinoma, Squamous Cell/surgery
, Female
, Follow-Up Studies
, Glottis
, Humans
, Laryngeal Neoplasms/pathology
, Laryngeal Neoplasms/radiotherapy
, Laryngeal Neoplasms/surgery
, Male
, Middle Aged
, Mouth
, Neoplasm Staging
, Postoperative Care/methods
, Prospective Studies
, Single-Blind Method
, Treatment Outcome