Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3134-z
Head and Neck
Impact of indication‑shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma A. Boehm · F. Lindner · G. Wichmann · U. Bauer · C. Wittekind · M. Knoedler · F. Lordick · S. Dietzsch · M. Scholz · R. Kortmann · A. Dietz
Received: 3 February 2014 / Accepted: 3 June 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III–IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also A. Dietz and R. Kortmann have equally contributed to the publication and have shared senior authorship. A. Boehm (*) · F. Lindner · G. Wichmann · A. Dietz Department of Otolaryngology, Head and Neck Surgery, University Hospital of Leipzig, Liebigstraße 10‑14, 04103 Leipzig, Germany e-mail: [email protected]‑leipzig.de U. Bauer · C. Wittekind Department of Pathology, University of Leipzig, Leipzig, Germany M. Knoedler · F. Lordick University Cancer Center (UCCL), University of Leipzig, Leipzig, Germany S. Dietzsch · R. Kortmann Department of Radiation Oncology, University of Leipzig, Leipzig, Germany M. Scholz Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p N1, largest node >3 cm, and especially if multiple of these risk factors are present [3]. The results of the landmark phase-III studies performed by the European Organization for Research and Treatment of Cancer (EORTC) [4], Radiation Therapy Oncology Group (RTOG 9501) [5], and radiotherapy cooperative clinical trials group of the German Cancer Society (ARO) [6] reporting about platinum-based postoperative radiochemotherapy (PORCT) led to changes in treatment recommendations since 2004 [7]. Therefore, the indication to perform PORT alone after resection of advanced LHSCC has switched to simultaneous platinum-based PORCT in patients at “intermediate risk” (R0
Head and Neck
Impact of indication‑shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma A. Boehm · F. Lindner · G. Wichmann · U. Bauer · C. Wittekind · M. Knoedler · F. Lordick · S. Dietzsch · M. Scholz · R. Kortmann · A. Dietz
Received: 3 February 2014 / Accepted: 3 June 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III–IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also A. Dietz and R. Kortmann have equally contributed to the publication and have shared senior authorship. A. Boehm (*) · F. Lindner · G. Wichmann · A. Dietz Department of Otolaryngology, Head and Neck Surgery, University Hospital of Leipzig, Liebigstraße 10‑14, 04103 Leipzig, Germany e-mail: [email protected]‑leipzig.de U. Bauer · C. Wittekind Department of Pathology, University of Leipzig, Leipzig, Germany M. Knoedler · F. Lordick University Cancer Center (UCCL), University of Leipzig, Leipzig, Germany S. Dietzsch · R. Kortmann Department of Radiation Oncology, University of Leipzig, Leipzig, Germany M. Scholz Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p N1, largest node >3 cm, and especially if multiple of these risk factors are present [3]. The results of the landmark phase-III studies performed by the European Organization for Research and Treatment of Cancer (EORTC) [4], Radiation Therapy Oncology Group (RTOG 9501) [5], and radiotherapy cooperative clinical trials group of the German Cancer Society (ARO) [6] reporting about platinum-based postoperative radiochemotherapy (PORCT) led to changes in treatment recommendations since 2004 [7]. Therefore, the indication to perform PORT alone after resection of advanced LHSCC has switched to simultaneous platinum-based PORCT in patients at “intermediate risk” (R0
