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

Purpose: To review the UCSF-SUH experience in the treatment of advanced T3- 4 laryngeal carcinoma and to evaluate the different factors affecting locor egional control and survival. Methods and Materials: We reviewed the records of 223 patients treated for T3-4 squamous cell carcinoma of the larynx between October 1, 1957, and Dec ember 1, 1999. There were 187 men and 36 women, with a median age of 60 yea rs (range, 28-85 years). The primary site was glottic in 122 and supraglott ic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 les ions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N 3 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 p rimary treatment modality in 161 patients, of which 134 had postoperative r adiotherapy (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 (I,RC) 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. Results: The median follow-up was 41 months (range, 2-367 months) for all p atients and 78 months (range, 6-332 months) for alive patients. The LRC rat e was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LR C on univariate analysis were primary site, N stage, overall stage, the low est hemoglobin (Hgb) level during RT, and treatment modality. Favorable pro gnostic factors for LRC on multivariate analysis were lower N stage and pri mary surgery. The overall survival rate was 48% at 5 years and 34% at 10 ye ars. Significant prognostic Factors for OS on univariate analysis were: pri mary site, age, overall stage, T stage, N stage, lowest Hgb level during RT , and treatment modality. Favorable prognostic factors for OS on multivaria te analysis were lower N stage and higher Hgb level during RT. Conclusion: Lower N-stage was a favorable prognostic factor for LRC and OS. Hgh levels greater than or equal to 12.5 g/dL, during RT was a favorable p rognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatm ent should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas. (C) 200 1 Elsevier Science Inc.