Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Reassessing the Role of Primary Chemoradiation Compared to Surgery for Large Volume (LV) T4 Laryngeal Cancer: Analysis using the Surveillance-Epidemiology-End Results (SEER) Database Joehar Hamdan DO 1,2, Mohammad Kawji MD 1,2, Lawrence Feldman MD 1 1. University of Illinois in Chicago 2. Advocate Christ Medical Center Introduction/Purpose of Study Randomized trials established chemo-radiotherapy as standard treatment for advanced laryngeal cancer. Patients with large-volume T4 disease (LVT4) were excluded from these trials. The purpose of this study was to report LVT4 laryngeal cancer patient outcome, including those treated with standard upfront laryngectomy versus those who did not. Background/Significance In previously reported series of patients with T4 laryngeal tumors treated with radiation alone, suboptimal rates of local control and diseasespecific survival were reported 1 The study published by Knab et al.2 had brought to our attention the need to further investigate the convention that patients with large volume T4 (LVT4) laryngeal tumors (LT) should be treated with upfront laryngectomy. LVT4 LTs are defined as tumor extension > 1 cm into the base of the tongue or extension of the tumor through the thyroid cartilage.2 The objective of our study was to determine the survival of patients who underwent surgery of the primary site versus those who did not in an effort to consider new approaches to treatment of patients with LVT4 LTs. Methods and Procedures Retrospective analysis of patients with LVT4 laryngeal cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER 17) database from the National Cancer Institute (NCI) for patients diagnosed between 1996–2006. SEER is an authoritative source of information on cancer incidence and survival in the United States. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Results Methods and Procedures Continued SEER currently collects and publishes cancer incidence and survival data from population-based cancer registries covering approximately 26 percent of the US population. SEER coverage includes 23 percent of African Americans, 40 percent of Hispanics, 42 percent of American Indians and Alaska Natives, 53 percent of Asians, and 70 percent of Hawaiian/Pacific Islanders. The SEER registries routinely collect data on patient demographics, primary tumor site, tumor morphology, and stage of cancer at the time of diagnosis by means of using standardized procedures and forms.4 Conclusions/Discussion Continued In narrative, tabular, or graphic form here. References 1. Mendenhall WM. T3-4 squamous cell carcinoma of the larynx treated with radiation therapy alone. Semin Radiat Oncol 1998; 8: 262–269. Subjects Data on all male and female patients ages 30 and above with T4a or T4b, any N and M0 or MX LT were obtained by using American Joint Committee on Cancer (AJCC) staging system (6th edition). We divided these patients into three groups. •The first group consisted of patients who had upfront site specific surgery (tumor destruction or resection) followed by radiation (beam RT, radioactive implants, radioisotopes, or combination beam RT with implants or isotopes). •The second group consisted of those patients who underwent surgery of the primary site but did not receive radiation. •The third group consisted of those who had upfront radiation +/-chemotherapy but did not have surgery to the primary site. Patients who did not have upfront surgery had refused it, had other medical conditions contraindicating it, or the reason was listed as unknown. Induction chemotherapy is an attractive treatment option, as it allows the assessment of tumor response and the selection of appropriate patients for organ preservation while improving local control and reducing the rate of distant metastasis. Although we were not able to determine whether or not these patients had chemotherapy and if so, which agents were used, in light of our findings and with advances in treatment modalities we believe the role of induction chemo-radiation as opposed to upfront surgery as primary treatment for LVT4 LT requires further investigation. Results The total number of patients examined were 477. The 32 month overall survival (OS) calculated by using the Kaplan-Meier method resulted in the following: •The patients who underwent surgery and postoperative XRT (N = 327) had an OS of 52.7% at 32 months, CI 95%. •The patients who underwent surgery without radiation therapy (N = 105) had an OS of 39.2% 32 months, CI 95%. •The patients who had primary XRT but no surgery (N = 45) had a OS of 52.4% at 32 months, CI 95% Conclusions/Discussion Treatment for head-and-neck malignancies has evolved with recent advances in chemo radiotherapy. These include the use of biological agents such as EGFR, VEGF, and tyrosine kinase inhibitors. In addition, advances in radiotherapy (RT) such as using PET-CT-guided RT versus conventional CT-guided radiotherapy in which the latter overestimated tumor volume by 150%, prolonged tolerance to chemo radiotherapy treatment.5 Randomized trials in patients with stage 3 and 4 locally advanced LT have demonstrated that induction chemotherapy followed by RT in some cases has been equivalent to surgery and resulted in a 64% rate of organ preservation.5 2 . B. R. Knab et al. Functional organ preservation with definitive chemoradiotherapy for T4 laryngeal squamous cell carcinoma Annals of Oncology 19: 1650–1654, 2008 3. Forastiere AA, Goepfert H, Maor M et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349: 2091–2098. 4. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 9 Regs Limited-Use, Nov 2007 Sub (1973-2005) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2005 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008, based on the November 2007 submission. 5. Heron DE, Andrade RS, Flickinger J, et al. Hybrid PET-CT simulation for radiation treatment planning for head-and-neck cancers: a brief technical report. Int J Radiation Oncology Bio Phys 2004:60:1419-24 Contact information Joe Hamdan 9906 Shady Lane Unit 5604 Orland Park, IL 60462 T: 708-307-2451 E: [email protected]