Salvage Following Transoral Laser Microsurgery for Early Glottic Cancer in National Veteran Database.
Aged
Aged, 80 and over
Chemoradiotherapy, Adjuvant
/ statistics & numerical data
Databases, Factual
/ statistics & numerical data
Female
Glottis
/ pathology
Humans
Laryngeal Neoplasms
/ diagnosis
Male
Microsurgery
/ adverse effects
Middle Aged
Natural Orifice Endoscopic Surgery
/ adverse effects
Neoplasm Recurrence, Local
/ epidemiology
Neoplasm Staging
Radiotherapy, Adjuvant
/ statistics & numerical data
Retrospective Studies
Salvage Therapy
/ methods
Squamous Cell Carcinoma of Head and Neck
/ diagnosis
United States
/ epidemiology
United States Department of Veterans Affairs
/ statistics & numerical data
Squamous cell carcinoma
early glottic cancer
radiotherapy
salvage treatment
transoral laser microsurgery (TLM)
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
07
06
2021
received:
11
03
2021
accepted:
28
06
2021
pubmed:
24
7
2021
medline:
25
11
2021
entrez:
23
7
2021
Statut:
ppublish
Résumé
Transoral laser microsurgery (TLM) is commonly utilized for early glottic cancer and offers favorable oncologic and functional outcomes. However, the survival implications of salvage therapy for recurrent or persistent disease have not been definitively characterized. Retrospective, national database cohort study. Data were extracted from Veterans Health Affairs (VHA) Informatics and Computing Infrastructure (VINCI) concerning the TLM-based management of T1-T2 glottic squamous cell carcinoma patients between 2000 and 2017. Patients were characterized as either requiring TLM-only, or in cases of persistent or recurrent local disease, TLM plus change in treatment modality (radiotherapy, chemoradiotherapy, or open surgery). Predictors of overall survival (OS), cancer-specific survival (CSS), and salvage-free survival were evaluated via Cox and Fine-Gray models. About 553 patients (70.9% T1a, 13.4% T1b, 15.7% T2) were included, with a median follow-up time of 74.5 months. The need for non-TLM salvage increased along with more advanced disease (11.7% T1a, 29.7% T1b, 32.2% T2). Compared to patients with T1a disease, those with T1b and T2 tumors initially treated with TLM had a significantly higher probability of receiving non-TLM salvage (T1b: HR 2.70, 95% CI: 1.61-4.54; T2: HR 3.02, 95% CI: 1.88-4.84). In a multivariable model, receipt of non-TLM salvage was not a significant predictor of either OS (HR = 0.91, 95% CI: 0.62-1.33, P = .624) or CSS (HR 1.21 95% CI 0.51-2.86, P = .667). The majority of patients with early glottic cancer that are managed with TLM do not require additional salvage therapy. When non-TLM salvage was required, there was no decrement in OS or CSS. 4 Laryngoscope, 131:2766-2772, 2021.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2766-2772Subventions
Organisme : UCSD School of Medicine, MedGap Program
Informations de copyright
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.
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