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Inicio Acta Otorrinolaringológica Española Results of an organ conservation protocol in patients with locally advanced lary...
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Vol. 60. Issue 3.
Pages 176-185 (January 2009)
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Vol. 60. Issue 3.
Pages 176-185 (January 2009)
Results of an organ conservation protocol in patients with locally advanced laryngeal tumours
Resultados de un protocolo de preservación de órgano en pacientes con tumores localmente avanzados de la laringe
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Xavier León
Corresponding author
xleon@santpau.cat

Corresponding author.
, Montserrat López, Jacinto García, Miquel Quer
Servicio de Otorrinolaringología, Hospital de Sant Pau, Barcelona, Spain
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Article information
Abstract
Introduction and objectives

Advanced laryngeal carcinoma patients, candidates for total laryngectomy, nowadays have different treatment options. One of them is induction chemotherapy, which allows modulation of the second manoeuvre according to the degree of response achieved. This study presents the results of a large series of patients treated according to this protocol.

Methods

Retrospective study of 370 patients with T3-T4 carcinomas of the larynx considered as candidates for total laryngectomy. All patients were treated with the protocol mentioned above.

Results

Seven patients died as a consequence of the treatment with chemotherapy. Among 363 patients finishing chemotherapy, 154 (43%) achieved complete response and proceeded with radiotherapy. Total laryngectomy was performed in 135 (37%) non-responders and 74 patients (20%) were treated with radiotherapy in spite of an incomplete response to chemotherapy. Overall actuarial survival was 73% at 5 years. Survival for patients with complete response and treated with radiotherapy was 77% and for non-responders subjected to total laryngectomy it was 76%. Non-responders treated with radiotherapy had a 5-year survival rate of 64%, significantly different to both other groups (P=.01). Larynx preservation was achieved in 42% of the patients, rising to 72% for complete responders to chemotherapy and to 62% in nonresponders receiving radiotherapy.

Conclusions

Our larynx preservation protocol including induction chemotherapy for patients with advanced carcinomas who are candidates for total laryngectomy achieved a total survival rate of 73% with a 42% larynx preservation rate. The response to the induction chemotherapy was the factor contributing most to larynx preservation.

Keywords:
Laryngeal carcinoma
Organ preservation
Induction chemotherapy
Resumen
Introducción

Una alternativa de tratamiento para los pacientes con carcinomas localmente avanzados de la laringe candidatos a laringectomía total es iniciar quimioterapia de inducción. El objetivo del presente estudio es analizar los resultados en una serie amplia de pacientes tratados de acuerdo con este esquema.

Métodos

Estudio retrospectivo de los resultados obtenidos en 370 pacientes con carcinomas de laringe T3-T4, considerados candidatos a laringectomía, que iniciaron tratamiento con quimioterapia.

Resultados

Siete de los pacientes fallecieron como consecuencia de la quimioterapia. De los 363 pacientes que completaron el tratamiento, 154 (43%) con respuesta completa y 74 (20%) sin respuesta completa fueron tratados con radioterapia, y 135 (37%) sin respuesta completa se sometieron a laringectomía. La supervivencia actuarial a los 5 años para el total de los pacientes fue del 73%. La supervivencia para los pacientes con respuesta completa tratados con radioterapia y para los tratados con cirugía fue del 77 y el 76%, respectivamente, mayor que la de los pacientes con radioterapia que no consiguieron una respuesta completa (64%) (P=0,01). Se consiguió la preservación de la laringe en un 42% de los pacientes: el 72% de los que consiguieron una respuesta completa con quimioterapia y el 62% de los tratados con radioterapia sin respuesta completa.

Conclusiones

La aplicación de un protocolo de preservación de órgano que incluía quimioterapia de inducción en pacientes con carcinomas de la laringe candidatos a laringectomía total consiguió una supervivencia del 73%, con una tasa de preservación laríngea del 42%. El factor pronóstico más importante para la preservación fue la respuesta a la quimioterapia.

Keywords:
Carcinoma de laringe
Preservación de órgano
Quimioterapia de inducción

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