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- Title
Postoperative Radiotherapy for High-risk Laryngeal or Hypopharyngeal Squamous Cell Carcinoma.
- Authors
Kropp, L.; Dagan, R.; Morris, C. G.; Bryant, C.; Werning, J. W.; Dziegielewski, P.; Mendenhall, W. M.; Amdur, R. J.
- Abstract
Objectives: To review the outcome of patients with positive / close margins and / or extracapsular extension (ECE) of lymph nodes who underwent radiotherapy (RT) with or without chemotherapy following radical surgery for laryngeal or hypopharyngeal squamous cell carcinoma, and to determine the factors associated with poor prognosis. Methods: We retrospectively reviewed the records of patients with positive / close margins and / or ECE who underwent RT with or without chemotherapy following radical surgery for laryngeal or hypopharyngeal squamous cell carcinoma. Results: In 70 men and 15 women aged 40 to 82 years, their primary lesions were graded as stage III (n = 6), IVA (n = 61), or IVB (n = 18). 73% of patients had either ECE (29%) or a high-risk margin (44%), and 27% of patients had both. The median RT dose was 64 (range, 54-76) Gy. The median follow-up periods for all patients and living patients were 2.5 and 4.0 years, respectively. The median times to locoregional failure and distant failure were 1.0 and 0.8 years, respectively. The 5-year rates for locoregional control, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival were 72%, 69%, 47%, 52%, and 35%, respectively. These 5-year rates were poorer in patients with both ECE and positive / close margins than in those with one high-risk feature only (50% vs. 79%, 50% vs. 77%, 19% vs. 60%, 18% vs. 66%, and 16% vs. 42%, respectively). The presence of ECE consistently resulted in poorer 5-year outcomes. Patients with more pathologic features had poorer 5-year outcomes. 23 patients developed acute or late complications of grade 3 or higher. Two patients had grade-5 toxicity; one died during hospitalisation after surgery for an oesophageal perforation and the other had multiple organ failure. Conclusion: In patients with positive / close margins and / or ECE, postoperative RT reduced the risk of recurrence. Patients with both high-risk pathologic features are at a higher risk of locoregional and distant failures and should undergo aggressive adjuvant or innovative treatment.
- Publication
Hong Kong Journal of Radiology, 2017, Vol 20, Issue 2, p110
- ISSN
2223-6619
- Publication type
Article
- DOI
10.12809/hkjr1715373