A Retrospective Analysis of Treatment of Advanced Laryngeal Squamous Cell Carcinoma at the Clinical Oncology Department Ain Shams University Hospitals

Abstract Background Laryngeal squamous cell carcinoma is one of the most common head and neck malignancies, and up to 40% of patients present with advanced disease. Several studies have proven the prognostic significance of different parameters including age, sex, smoking, grade, staging, and different treatment modalities. Aim of the Work To retrospectively study and analyze the treatment modalities of advanced stage laryngeal cancer, factors affecting response to treatment, and survival including overall survival (OS) and progression free survival (PFS). Patients and Methods We conducted a retrospective study of 60 patients' charts histopathologically diagnosed with advanced stage laryngeal squamous cell carcinoma. The patients were treated at the head and neck clinic at the Clinical Oncology Department, Ain Shams University, between January 2016 and December 2020. We reviewed patient demographics, tumor characteristics, treatment modalities, and survival data. Results Sixty patients were accrued in our study. The mean age of the patients was 62 years, and 93.3% were male. The most common site affected was the glottic area, and smoking was a risk factor in 83.3% of patients. Majority of the tumors had a moderate degree of differentiation (G2). All the patients had squamous cell carcinoma. Treatment modalities showed statistically significance effect on the response to treatment. The patients treated with total laryngectomy plus radiotherapy and/or chemotherapy achieved complete response compared to the patients who were treated with chemo-radiation or radiotherapy alone (p > 0.001). Tumor grading, nodal staging and T staging tended to positively affect response to treatment but did not reach statistical significance. The percentage of the patients with G1 disease who achieved complete response was 100% (p > 0.37), the patients percentage with nodal negative disease who achieved complete response was 62.1% (p > 0.57) and regarding T staging the percentage of the patients in stage III, IV who achieved complete response was 50%, 64.3% respectively (p > 0.27). Of the different tumor factors, only the tumor grade showed a statistically significant impact on survival. The 5-year overall survival rate (OS) was 100% for grade I, 67.6% for grade II, and 53.3% for grade III (p < 0.04). Other factors with negative impact on survival but did not reach statistical significance were site of the tumor and tumor stage. The percentage of the patients with stage III and IV who remain alive was 66.7% and 63.3% respectively (p > 0.41). Regarding tumor site the 5-years OS was 71.9 for glottic tumors, 50% for supraglottic tumor and 70% for transglottic tumor (p > 0.37). Our study aimed to assess the PFS, unfortunately it couldn’t be assessed as the number of patients who developed progression was only 3/60(5%) patients and 57/60 (95%) of the patients did not show progression. The mean OS of our study was 32 months and the median OS was 34 months. Conclusion Our study revealed that total laryngectomy plus radiotherapy and/or chemotherapy is the preferred treatment modality for advanced laryngeal cancer patients. Tumor grade is one of the most significant prognostic factors and is a predictor of survival.