Karlsson Therese R, Al-Azzawe Mohammed, Aziz Luaay, Hurman David, Finizia Caterina
Department of Otorhinolaryngology, Head and Neck Surgery Sahlgrenska University Hospital, Gothenburg University, SE 413 45, Gothenburg, Sweden,
Eur Arch Otorhinolaryngol. 2014 Mar;271(3):547-54. doi: 10.1007/s00405-013-2657-z. Epub 2013 Aug 31.
In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.
鉴于III期和IV期喉肿瘤治疗效果仍存在不确定性，本研究旨在评估器官保留策略，包括放射治疗和放化疗与手术治疗（喉切除术±辅助治疗），方法是纳入两个国际知名的三级医疗中心长期以来的实践经验，这些经验此前未在已发表的文献中呈现。对瑞典哥德堡的萨尔格伦斯卡大学医院（SU）和苏格兰阿伯丁的阿伯丁皇家医院（ARI）这两个三级医疗中心前瞻性维护的非随机III期和IV期疾病患者数据库进行回顾性分析。主要结局指标包括根据治疗情况的3年总生存率、疾病特异性生存率和局部控制率。共确定了176例患者。65例（37%）为III期肿瘤患者，其中51例接受了器官保留治疗，14例接受了全喉切除术。111例（63%）IV期疾病患者的相应数字分别为42例和69例。III期患者的3年总生存率和疾病特异性生存率分别为58%和73%。IV期疾病的相应数字分别为42%和53%。治疗选择似乎对III期（p = 0.56）或IV期（p = 0.93）疾病的生存率没有显著影响。治疗选择，无论是器官保留还是手术，似乎都不会显著影响总生存率或疾病特异性生存率。因此，其他因素，如生活质量、嗓音以及挽救治疗的效果，可能更能表明首选的治疗方案，但仍需要更大规模的随机试验。
