Organ Preservation Protocol in Oropharyngeal Cancer
Authors:
H. Binková; Z. Horáková
; E. Tóthová; R. Kostřica
Authors‘ workplace:
Klinika ORL a chirurgie hlavy a krku LF MU a FN u sv. Anny, Brno
přednosta prof. MUDr. R. Kostřica, CSc.
Published in:
Otorinolaryngol Foniatr, 59, 2010, No. 3, pp. 114-121.
Category:
Original Article
Overview
Introduction:
Organ preservation protocol (OPP) is one of treatment modalities for advanced resectable head and neck cancer. OPP’s goal is to maintain the organ and its physiological function without compromising the tumor control in comparison to surgery.
Goal of the study:
Analysis of survival rates and quality of life in OPP and surgery groups
Methods:
We retrospectively reviewed data from 190 patients with resectable stage III or IV oropharyngeal squamous cell carcinoma treated in our hospital from 2001 through 2008. The primary tumor was surgically treated in 123 patients, in 67 patients non-surgically. The treatment strategies were multimodal. They comprised combined chemoradiation (concurrent or neoadjuvant) followed by neck dissection or salvage surgery, if necessary.
Results :
Out of total 67 OPP patients, the treatment was completed by 62 (93%). 47 patients (70%) achieved complete response. 41 patients (61%) were healed by conservative treatment only without any surgery (organ preservation). The remainder, 6 patients, underwent salvage surgery. Survival rates in organ preserving group were as follows: OAS (overall survival) 49% and 41% at 3 and 5 years, respectively; DSS (disease-specific survival) 58% and 51% at 3 and 5 years, respectively; DFI (disease-free interval) 69% and 69%, respectively. OAS in surgical group was 64% and 53% at 3 and 5 years, respectively. DSS of 76% and 72% at 3 and 5 years, respectively, were observed. DFI of 80% and 77%, respectively, became obvious. In survival rates there was a statistically significant difference in survival rates in favor of surgery group: in OAS (Gehan-Wilcox p=0.015, Cox-Mantel p=0.013) and DSS (Gehan-Wilcox p=0.014, Cox-Mantel p=0.010).
To assess the impact of therapy on quality of life and function of preserved organ – tracheostomy and gastrostomy dependence and duration of their median use was analysed in both categories. In organ preserving group 20 patients (30%) needed tracheostomy for duration of 33 weeks in median. 10 patients (15%) required tracheostomy permanently. 41 patients (61%) required gastrostomy for 32 weeks in median, but 15 patients (22%) used gastrostomy permanently. In surgery group 79 patients (64%) needed tracheostomy, with median duration of 34 weeks. 23 patients (19%) needed permanent tracheostomy. 36 patients (29%) used gastrostomy for median time 30 weeks, but 13 patients (11%) remained gastrostomy-dependent.
Conclusion:
The survival rates (OAS, DSS, DFI) in the surgery group exceeded that of the organ preserving group statistically. No significant difference in quality of life was demonstrated between both categories on account of high toxicity and adverse effects of chemoradiation.
Key words:
oropharynx, cancer, organ preservation protocol, surgery, survival, quality of life.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
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