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

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• 作者：Alvaro Sanabria^a ; Aline L.F. Chaves^b ; Luiz P. Kowalski^c ; Gregory T. Wolf^d ; Nabil F. Saba^e ; Arlene A. Forastiere^f ; Jonathan J. Beitler^g ; ^h ; ⁱ ; Ken-ichi Nibu^j ; Carol R. Bradford^d ; Carlos Suá ; rez^k ; ^l ; Juan P. Rodrigo^k ; ^m ; Primož Strojanⁿ ; Alessandra Rinaldo^o ; Remco de Bree^p ; Missak Haigentz Jr.^q ; Robert P. Takes^r ; Alfio Ferlito^s ; ^{a.ferlito@uniud.it}
• 关键词：Organ preservation ; Chemoradiotherapy ; Advanced laryngeal cancer ; Laryngeal neoplasm ; Laryngectomy ; Controlled clinical trials ; Bias ; Outcomes assessment
• 刊名：Auris Nasus Larynx
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：44
• 期：1
• 页码：18-25
• 全文大小：408 K
• 卷排序：44

文摘

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.MethodsA comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies.ResultsA variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise.ConclusionsPersonalized 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.