Retrospective evaluation of prognostic factors in patients with laryngeal cancer who underwent radioation theraphy

Introduction and purpose: Laryngeal cancer which is a cancer seen in the body, constitutes 2-5% of men and 0,4% of women. It takes the second place in the part of the head and neck except for skin cancer. The purpose of this study is to investigate the effect of prognostic factors related to tumor and treatment on the overall survival and disease-free survival of patient. Material and Method: In this study, 95 patients who underwent radiotherapy with the diagnosis of laryngeal squamous epithelial cell carcinoma in the Department of Radiation Oncology, School of Medicine University of Dicle between November 2002 and January 2011 were evaluated retrospectively. Patients were evaluated according to their age, sex, hemoglobin, T stage, N stage, tumor location, involvement of anterior commissure, involvement of cartilage, surgical treatment status, surgical border, perineal invasion, lymph vascular invasion, treatment of concurrent chemotherapy and interruption during treatment. Results: Of 95 patients, 88 were male (92,6%) and 7 were female (7,4%). Age of the patients ranged from 39 years to 84 years and median of the ages was 61 years. Pathological diagnosis of all patients were squamous cell carcinoma. Fourteen patients (14,7%), 19 patients (20%), 19 patients (20%) and 43 patients (45,3%) were evaluated as T1, T2, T3 and T4, respectively. Sixty seven patients (70,5%), 20 patients (21,1%), 8 patients (8,4%) are valued as N0, N1 and N3, respectively. Fourteen patients (14,7%), 11 patients (11,6%), 24 patients (25,3%) and 46 patients (48,4%) were evaluated as Stage I, Stage II, Stage III and Stage IV, respectively. Nineteen patients (20%) have well differentiated tumors, 56 patients (58,9%) have moderately differentiated tumor and 8 patients (21,1%) have poorly differentiated tumor. When viewed as the primary, tumor sites are located as supraglottic in 41 (43,2%) patients, glottic in 53 patients (55,8%) and subglottic in 1 (1,1%). Cartilage extention was avaliable in 41 patients (43,2%) and was not available in 54 patients (56,8%). Anterior commissure extension was available in 42 patients (44,2%), anterior commissure extension was not available in 53 patients (55,8%). Surgery was applied to 47 patients (49,5%) and not applied to 49 patients (50,5%). Total laryngectomy was applied to 40 patients (42,1%) and partial laryngectomy was applied to 7 patients (7,4%). Surgical border was positive in 19 patients (20%), was close in 9 patients (9,5%) and negative in 19 patients (20%). There were 7 (%7,4) patients applied surgery with perineural invasion and 40 (%42,1) without perineural invasion and 11 (%11,6) with lymphovascular invasion and 36 (%37,9) without lymphovascular invasion. Average hemoglobin level was below 12 gr/dl before radiotherapy. The median follow-up was 17 months. Recurrence was seen in 15 (15,7%) patients and lung cancer was seen as seconder in 4 (4,2%) patients after treatment. In univariate analysis, the Nodal stage (p=0,010) and the degree of tumor differentiation (p=0,036) were statistically significant when evaluated in terms of overall survival. The Nodal stage (p=0,009) and anterior commissure involvement (p=0,008) were statistically significant when evaluated in terms of disease-free survival. The statistically significant data in overall survival were included the in multivariant cox regression analysis in univariate analysis. The Nodal stage (p = 0,020) yielded significant results when interpreting these data. The statistically significant data in disease-free survival were also included in the multi variant cox regression analysis in the univariate analysis. The Nodal stage (p=0,005) and anterior commissure involvement (p = 0,011) yielded significant results while considering these data. Conclusion: We were found that nodal involvement of laryngeal cancer increases both the local and regional risks and affects overall survival of patients adversely. Besides, we were observed that the anterior commissure involvement increases the local recurrence.