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

Alvaro Sanabria; Aline L F Chaves; Luiz P Kowalski; Gregory T Wolf; Nabil F Saba; Arlene A Forastiere; Jonathan J Beitler; Ken-Ichi Nibu; Carol R Bradford; Carlos Suárez; Juan P Rodrigo; Primož Strojan; Alessandra Rinaldo; Remco de Bree; Missak Haigentz Jr; Robert P Takes; Alfio Ferlito

doi:10.1016/j.anl.2016.06.005

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

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

Authors

Alvaro Sanabria¹, Aline L F Chaves², Luiz P Kowalski³, Gregory T Wolf⁴, Nabil F Saba⁵, Arlene A Forastiere⁶, Jonathan J Beitler⁷, Ken-Ichi Nibu⁸, Carol R Bradford⁴, Carlos Suárez⁹, Juan P Rodrigo¹⁰, Primož Strojan¹¹, Alessandra Rinaldo¹², Remco de Bree¹³, Missak Haigentz Jr¹⁴, Robert P Takes¹⁵, Alfio Ferlito¹⁶

Affiliations

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.

PMID: 27397024
DOI: 10.1016/j.anl.2016.06.005

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.

Publication types

Review

MeSH terms

Chemoradiotherapy*
Cohort Studies
Humans
Laryngeal Neoplasms / pathology
Laryngeal Neoplasms / therapy*
Laryngectomy
Neoplasm Staging
Organ Sparing Treatments*
Outcome Assessment, Health Care
Patient Compliance
Randomized Controlled Trials as Topic
Treatment Outcome