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Auris Nasus Larynx. 2017 Feb;44(1):18-25. doi: 10.1016/j.anl.2016.06.005. Epub 2016 Jul 5.

Organ preservation with chemoradiation in advanced laryngeal cancer: The problem of generalizing results from randomized controlled trials.

Author information

1
Department of Surgery, School of Medicine, Universidad de Antioquia, Fundación Colombiana de Cancerología - Clínica Vida, Medellin, Colombia.
2
Fundaçao Geraldo Correia/Hospital São João de Deus, Divinopolis, MG, Brazil.
3
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
4
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
5
Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA.
6
Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
7
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA; Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
8
Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
9
Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain; Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain.
10
Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain; Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
11
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
12
University of Udine School of Medicine, Udine, Italy.
13
Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
14
Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
15
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
16
Coordinator of the International Head and Neck Scientific Group. Electronic address: a.ferlito@uniud.it.

Abstract

BACKGROUND:

The primary goal of treatment in advanced laryngeal cancer is to achieve optimal oncologic outcomes while preserving function and quality of life. Combination of chemotherapy and radiation has been popularized as an alternative to surgery for patients facing total laryngectomy. However, survival analyses from large, population-based databases have not duplicated results reported from randomized trials.

METHODS:

A comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies.

RESULTS:

A variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise.

CONCLUSIONS:

Personalized treatment considering all factors is critical for optimal outcomes. In general, evidence supports total laryngectomy for patients with T4 cancers. Definitive chemoradiotherapy strategies are acceptable alternatives for T3 cancers, provided that all resources for the administration of the treatment, follow-up and surgical salvage are available.

KEYWORDS:

Advanced laryngeal cancer; Bias; Chemoradiotherapy; Controlled clinical trials; Laryngeal neoplasm; Laryngectomy; Organ preservation; Outcomes assessment

PMID:
27397024
DOI:
10.1016/j.anl.2016.06.005
[Indexed for MEDLINE]

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